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Boston

Medical Library

8 The Fenway

Vol. VII. No. 5.

The Journal of
Mental Pathology

Subscription Price: — $2.50 per annum. Single Copies, 50 cents.

Edited by Louise G. Robinovitch, B. £s L., M.D.

(Ebttortal Boarb

Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K.
MILLS (Phila.), Dr. G. MINGAZZINI, Dr. SANTE DE SANCTIS, Prof. L
LUCIANI (Rome), Dr. JUL. MOREL (Belgium), Dr. E. REGIS (Bordeaux).

Contributors' Staff

BALLET, Prof. G. (Paris); BLEULER, Prof. E. (Zurich); BOURNEVILLE,
Ed. Progress MSdical; CANNIEU, Prof. (Bordeaux) ; CERLETTI, Dr. Ugo (Rome) ;
CHATTERJI, J. C. (Benares, India); CLAPAREDE, Ed. Arch, de Psychologic
(Switzerland); DAGONET, Dr. (France); DUCCESCHI, Dr. V. (Rome);
FABRIZI, Dr. G. (Rome); FAREZ, Dr. Paul; FERRI, Prof. E. (Rome);
GIANNELLI, Dr. A. (Rome) ; GUIDI, Dr. G. (Rome) ; LOURIE, Ossip, Ph. D.
(Paris); MARIE, Dr. A. (France); MARRO, Dir. Annali di Freniatria (Italy);
PERUSINI, Dr. G. (Rome); PIERON, Dr. H. (Paris); POLIMANTI, Dr. Osv.
(Rome) ; RITTI, Dr. Ant., Ed. Annates Midico-Psychologiques; SEMIDALOW, Dr.
B. (Moscow); SERGI, Prof. G.; SERGI, Dr. S. (Rome); SERBSKI, Prof. V. P.
(Moscow); SOUKHANOFF, Dr. S. (Moscow); TOULOUSE, Dr., Ed. Revue de
Psychiatrie; TSCHISCH, Prof. W. (Russia); VURPAS, Dr. CI. (France);
VASCHIDE, N. (Paris).

STATE PRESS, Publishers,

NEW YORK, N. Y.

MSS. and Communications should be Addressed to the Editor,
28 West 126th Street, New York.

INDEX TO VOLUME VII.

ORIGINAL CONTRIBUTIONS

PAGE

Clinical observation on a rare
case of "phobia," Pietro Tim-
pano 21

Cretinism in a dog, a study of
its thyroid gland, Drs. Ugo
Cerletti and Gaetano Peru-
sini 209

Degenerate ear, anatomo-an-
thropological sketch, the, V.
V. Vorobieff 57

Electrocution, an experimental
study with an electric current
of low tension. Illustrated by
cardiographic and respiratory
tracings, with some critical
remarks on the present meth-
od of the official electrocu-
tion, a preliminary communi-
cation, Louise G. Robino-
vitch 75

Electric sleep, an experimental
study with an electric current
of low tension, illustrated by

PAGE

cardiac and respiratory trac-
ings, a preliminary communi-
cation, Louise G. Robinovitch 172

Genesis of genius, the, Louise
G. Robinovitch 228

Heredo-syphilis, form — infantile
multiple sclerosis, familial
sclerotiform heredo-syphilis,
Sante De Sanctis and Gian
Luca Lucangelli 1

Neurasthenia and neuro-hypers-
thenia of Grocco, a critical
review, Pietro Timpano 167

Pathology of the neurofibrils,
the, Ugo Cerletti and L. Sam-
balino 11 3

Reflex and automatic excitabil-
ity, Sergio Sergi 161

Remarks on a specific human
energy and its economic and
social significance, Louise G.
Robinovitch 120

TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE

PAGE
A

Abolition of capital punishment
in Belgium, results of the
practical, Maynard Shipley.. 191

All crazy within 700 years 43

Acrania, a case of hydrocepha-
lus and, A. E. Engzelius 106

Alcoholism and idiocy, Le
Marc Hadour 52

Allison, Henry E 88

Alternating current of high vol-
tage, pernicious effects of . . . 136

Antitoxin for mushroom poi-
soning, W. W. Ford 20J

Anti-rabies vaccination in St.
Petersburg, annual report of
the Imperial Institute of Ex-
perimental Medicine, V.
Kraiouchkine 44

Ants and some other insects,
the psychical factulties of, A.
Forel 155

Armies of the greatest battles
in modern history, the 51

PAGE

Arterio-sclerosis, psychic dis-
turbances during the course
of cerebral, S. Soukhanoff
and I. Vedenski 32

Attention, a disease of the, Hos-
pital 152

Asexualization, Everett Flood. 35

Blind, contribution to the study
of the psychology of the, A.
Krogluss 142

Binuclear cells, experiments
made on Guinea-pigs by poi-
soning with phosphorus and
bacilli of yellow fever (San-
arelli), new data relating to
the study of, K. A. Kout-
chouk 45

Birth-rate declining steadily
since i860 99

Births, multiple and heredity. 204

Brain, the correct weight of
Prof. Taguchi's 180

INDEX.

PAGE

Brain, the weight of Prof. Ta-
guchi's 156

Brain weights, some results of a
study of variation and corre-
lation in, Raymond Pearl 184

Birth-rate, decline in and mor-
tality of infants, F. S. Krum 154

Cervical portion of the spinal
cord with post mortem exam-
ination, a case of injury to
the, J. Howard Morgan 37

Cerebellum, on some disput-
able points regarding the
physiology of the, M. L. Pa-
trizi 138

Cerebral physiology and theory
of volition, Paul Flechsig... 90

Cerebral cortex of the dolphin
(delphinus delphis), histolog-
ical research, the, V. Bianchi 151

Cerebral cortex, psychic func-
tion and the, Sciamanna 90

Chair of psychiatry, Rome, the 88

Chinese sympathy for the Jews. 202

Chorea, chronic progressive,
contribution to its clinical and
anatomopathological study,
Daddi 101

Chorea with anatomo-patho-
logic findings, a case of Hunt-
ington's, Carlo Besta 101

Congress of Psychology, the
V-th international 86

Congress of criminal anthropol-
ogy, sixth international 200

Congress of medicine, fifteenth
international 200

Consciousness and its degrees,
Paul Sollier 91

Consciousness after hanging,
persistence of 103

Consciousness and will-power,
the newest conception of 29

Consciousness from the medico-
legal point of view, the phas-
es of 25

Cretinism, studies of endemic,
U. Cerletti and G. Perusini.. 97

Continuous involuntary crying. 157

Crime record for quarter end-
ing June 30, 1904, New York
City's . .. 50

Criminal responsibility of in-
sane Malays, the normal Ma-
lay and the, Major Charles E.
Woodruff 95

Cysticercus in the aqueduct of
Sylvius, a case of, Zemblinov 185

Cytodiagnosis in psychiatry,
Clarence B. Farrar 190

D
Deaf and blind girl, an address
delivered by a 51

PAGE

Death, a sure sign of, acidifica-
tion of the viscera, Brisse-
morel and Ambard 49

Dementia precox, head trauma
and, A. D'Ormea 105

Dementia precox, researches in-
to the metabolic changes in,
D'Ormea and F. Maggioto... 104

Dementia precox, general con-
siderations of the clinical sig-
nificance of, Meeus . • 199

Dementia precox, on a special
form of the red blood corpus-
cles in, Pighini and Paoli 106

Diabetes with consideration on
the evolution of the disease, a
case of bronzed 42

Dreams during a period of one
hundred nights, study of, H.
Pieron 142

Dreams, stereotyped, Meunier.. 202

Deaf and dumb in Germany,
statistics of the, John Koren. 157

Echopraxia, psychologic and
clinical study of, Dromard.. 194

"Electric sleep," Louise G. Rob-
inovitch 91

Epilepsy and dechloridization,
Ch. Mirallie .. 193

Epilepsy, a rare case of reflex,
Ouspenski 143

Epilepsy, treatment of, hyper-
bromidization through hypo-
chloridization, Ch. Achard.. 40

Epilepsy, pathogenesis and ther-
apeutic indications, second
part : treatment of epilepsy,
Alexander Paris 38

Epilepsy in animals and man, a
comparative study of idiopath-
ic, L. Pierce Clark 52

Epileptic convulsive attacks and
urinary elimination, J. and R.
Voisin and Krantz .•••;•• 49

Execution in prisons, objection
to 51

Epileptoid foot trepidation and
surgical anesthesia, Lannois. 195

Epilepsy, new chemical re-
searches into, Paul Masoin.. 153

Evolution and involution of
peoples, influence of geo-
graphical surroundings and
heredity of acquired charac-
ters on the, A. Matteuzzi 140

Experimental contribution to
the study of so-called vital
electro-magnetism, by means
of the galvanometer, Ed. Gast
Desfossess 92

INDEX.

PAGE
F

Fatigue of school children, how-
should be measured, M. C.
Schuyten 156

Gamier, Dr. Paul 89

General paralysis, at the Acad-
emy of Medicine, Paris, the
question of the relation of
syphilis and, Georges Vernet. 93

General paralysis, clinical and
anatomopathological studies
of juvenile, F. Burzio 157

General paralysis, a case of
traumatic, Wahl 198

General paralysis, the histologi-
cal basis of remissions in 31

General paralysis and tabes dor-
salis, a contribution to the
study of the relation of, Hen-
ry Cotton 150

General paralysis, peculiarities
of memory in progressive,
Zacharchenko 201

Glucose in the cerebro-spinal
fluid, absence of, Dubos... 203

Goitre, the pathological anato-
my of exophthalmic, G. Mac-
Cullum . 102

Goitre in the Philippine Islands,
an area of endemic, Louis C.
Duncan 181

Gustatory sensibility in man and
woman, measuring, Vaschide. 49

Hallucinations and hallucina-
tory psychoses, on, Angiolella 197

Hallucinations, obj ective signs
of, Zaregradski 197

Heat and cold in circumscribed
areas of the skin, limits of
physiological tolerance to,
Marco Treves 143

Hemi-hypertrophy in which the
internal organs were also in-
volved, a case of, Robert
Hutchinson 46

Homicide, the cause of, collect-
ive . .' 180

Hysterical contractures, contri-
bution to the study of, A. Pi-
azza 106

Hysterical anesthesia to fatigue,
H. Pieron 142

Hysteria in children, develop-
ment of, L. Babonneix 43

Idiocy, the causes of, Kovalev-
ski 36

Idiocy, Mongolian type of, Ko-
valevsky 153

Idiots savants 34

Imperial differences, the cost of 180

PAGE

Inebriates in New York, a hos-
pital for 203

Inebriety and the so-called
cures, James Stewart • 194

Inheritance in man, Alice Pear-
main 155

Infantile cerebral hemiplegia
and hemiataxia, Bouchard... 46

Indian schools, progress in the. 41

Insanity and allied neuroses,
variation in relation to the
origin of, John Macpherson.. 188

Insane in Canada, T. J. W
Burgess ' jgg

K
Kills husband and daughter and

commits suicide i0y

Korsakoff's psychosis, report of

cases, Arthur W. Hurd 191

Korsakoff's psychosis, two cases

of, Patterson i$j

Laminectomy of the third and
fourth lumbar vertebrae for a
lesion of the cauda equina,
Roberto Alessandri 203

Locomotor ataxia successfully
treated with ultra-violet rays,
J. Monroe Lieberman 187

Lumbar puncture from the di-
agnostic and therapeutic
points of view, Gerhardt 39

Men and women, the relative
number of 196

Mental and nervous cases with
special reference to the poor,
some points in the early treat-
ment of, A. Helen Boyle 201

Mental healing, the element of
truth in, Lucy Waite 199

Mental diseases, some consid-
erations on the treatment of,
J. Christian 186

Mental disturbances among the
personnel of hospitals for the
insane, inquest into the fre-
quency of 104

Mentality of the lower animals,
experimental researches into
the, P. Hachet-Souplet 92

Mental disorders, some meta-
bolism studies with special
reference to, Otto Folin 33

Moral insanity with repeated

homicides and incendiarism and

late developemnt of delusions, a
case of, Henry R. Stedman.. 32

Mother kills her seven children
and mortally wounds herself. 202

Music, the love of 35

MyrmecidcT, psychological study
of a species of, Henri Pieron 92

INDEX.

PAGE

Nerve cells, concerning the con-
tinuity of the, and some other
matters connected therewith,
John Turner 192

Nervous elements of the spinal
cord in the chicken, the gen-
esis and correlation of the,
E. Lapegna 156

Nervous elements, on the fibril-
lary structure of the, M. I.
Gourevich : . 147

Nervous fibre in relation to its
function, the fine structure of
the, Carlo Besta 140

Nervous cells of the vertebrate,
the endocellular fibrillary net-
work and the axis-cylinders
of the various methods of
elective staining of the endo-
cellular and peripheral net-
work based on the action of
pyridin on nervous tissues,
Arturo Donaggio 48

Neurotoxic serum, by the meth-
od of rapid immunization,
preparation of a, Armand
Delilie 50

Notes of a visit to some foreign
hospitals, mainly in Germany,
E. N. Brush 150

Nyctophobia in children, R. Se-
net 155

Ocular paralyses, clinical con-
tribution to the study of, Gi-
ovanni Fabrizi 203

Pain, the sense of, Mile. J. Io-
teyko 182

Paramyoclonus multiplex, his-
to-pathologic researches into,
E. Poggio 198

Palate, comparative measure-
ments of the hard, in normal
and feeble-minded individuals,
a preliminary report, Walter
Channing and Clark Wissler. 151

Passion, specific characteristics
of, Th. Ribot 139

Parole system suggested, exten-
sion of 51

Pellagrogenous toxic agents,
experimental researches into
the anatomical localization in
dogs of the delirious symp-
tom due to, Carlo Ceni 91

Peopling the earth, believes in. 105

Philosophy and psychology,
Adechi Babatone 92

Pituitary body, on experiment-
al, secondary hypertrophy of
the, contribution to the study

PAGE

of the pathogenesis of acro-
megaly, Guido Guerrini 144

Poliomyelitis in the adult,
acute anterior, A. VanGe-
hutchten 106

Porencephalia, contribution to

the study of, O. Broglio 152

Princess Louise's examination.. 52

Princess Louise 88

Progressive paralysis, anatomo-
pathological and clinical con-
tribution to the study of the
relation of syphilis and, R.
Stanziale 154

Psychoses studied histological-
ly, considerations regarding
five cases of acute, A. De-
boubais 48

Psychic slowing and disturb-
ances of evocation of ideas
of the melancholiac, the,
Masselon 36

Psychology, a prospective les-
son in practical 179

Psychoses, the etiologic role of
syphilis in the, L. Marchand. 155

Psychic suffering of women as
one of the forms of sexual
psychopathia, Jakolev 149

Psychic hemiplegia in a para-
noiac, Zaregradski 157

Psychological notes on the Pa-
houin negroes, Alice Degal-
lier 148

Psychotherapy in the treatment
of sexual impulses, impor-
tance of, E. Berillon 141

Physiological concomitance of
pleasure and pain, an attempt
to determine the, Mario Govi 143

Public schools for the year
ending June 30, 1904, cost of
the 51

Race suicide, J. R. Allen 103

Race suicide in France 199

Reflex of the "extensor digito-
rum communis," on the, Ar-
turo Morselli 100

Rockefeller, John D., is a total

abstainer 107

Russian revolution, a detail in

the 202

Rhythm sense in primitive peo-
ples, the, Charles S. Myers . . 142

Saturnine intoxication, Ch. Mi-

rallie 40

Schopenhauer 157

Sciamanna, Professor Ezio.... 88
Sense disturbance following
extirpation of the columns of

INDEX.

PAGE

the spinal cord in dogs, V.

Ducceschi 137

Sensation and motion, Fred-
erick C. Gessner 34

Sexual inversion, a case of,

Antheaume and Parrot 154

Sexual continence 198

Shocked by 13,500 volts and

lives 179

Sibbald, Sir John 89

Sign of civilization 178

Simulation of mental and ner-
vous diseases among chil-
dren, Paul Moreau 104

Sleep, on the diseases of,
crimes committed during

somnambulism 135

Sleep, problems and theories

relating to, Claparede 146

Social peril, a veritable, volun-
tary depopulation, G. Eus-

tache .-•■:• 200

Somnambulistic sleep, while in
a, walked off car of a train
that was carrying him to sus-
pension bridge .••.••• I07

Status epilepticus, dechloridiza-
tion, bromism and, Voisin

and Rendu 202

Suicide, the question of med-
ico-psychological sketch, I.

M. Reichers 147

Syndrome of Brown-Sequard,
wound of the spinal cord,

Couteaud 204

Tamburini, Professor, to fill
the chair of psychiatry at the
University of Rome 137

Tabes dorsalis in children, M.
S. Margules 193

Tent treatment to additional
classes of the insane, exten-
sion of, C. F. Haviland and
Ch. L. Carlisle 191

PAGE

Tetanus cured by heroic doses
of antitoxin, severe case of,
Charles F. Davidson 105

Thought, on latent and syn-
chronous, Cesare Rivera 143

Thyroid gland, contribution to
the study of the physiology
of the, Petrovski 188

Thyroid gland, dwarfism and
its treatment with some forms
of, Bourneville 45

Touches a cable carrying 22,000
volts and lives, Oldright 192

Toxin of fatigue and its anti-
otxin, Wiechardt 48

Time, the appreciation of, in
children, Ida Faggiani 143

Tabes dorsalis, the question of
trophic disturbances during
the course of, V. Dobrokho-
tov 47

Tweed's son is said to have
committed suicide 107

Urinary elimination during the
course of dechloridization, J.
and R. Voisin and Krantz... 50

Useful work during sleep, ex-
ample of, P. Bovet 152

Vambery and his linguistic or-
gan .-••;•• I5°

Vibro - sensibility, contribution
to the study and interpreta-
tion of, V. Forli and B. Bar-
rovecchio 196

Vision in the insane and in
born delinquents, the field of
distinct, E. Audenino 141

War death roll of a century... 51
Warning to physicians of Colo-
rado 203

BOOK REVIEWS

PAGE

Alienes criminels et des crimi-
nels alienes, des, Marcel
Verin, These 56

Collection of neuropathological
and psychiatric works dedi-
cated to Prof. I. A. Sikorski
on the occasion of the com-
pletion of thirty-five years of
his medico-scientific career,
a, (1896-1904), by his stu-
dents, Kushneriev, Kiev, 1904 56

Contribute alio studio clinico
dell' emicrania (semplice e
accompagnata), with a pref-

PAGE

ace by Professor G. Mingaz-
zini, Mario Augusto Bioglio. 208

Criminalite de l'enfance, these,
Rennes, Rene Le Marc Ha-
dour 56

General psychology, with phys-
iological and graphic illustra-
tions, twenty-one colored
plates and 285 illustrations,
I. A. Sikorski 109

Geschlecht und Kinderliebe, P.
J. Moebius 55

Grundlinien einer Psychologie
der Hysterie, Willy Hellpach n 1

INDEX.

PAGE

Grundriss der Heilpaedagogik,
Theodor Heller in

Lezioni di anatomia clinica dei
centri nervosi, G. Mingazzini 112

Mental defectives, their his-
tory, treatment and training,
Martin W. Barr 53

Mental diseases. Vol. I, Gen-
eral psychopathology. Vol.
II, Special Psychiatry. A
textbook for physicians and
jurists, P. I. Kovalevski, 5th
edition 112

Moralischen Schwachsinn des
Weibes, ueber den, Katinka
von Rosen 55

Psychologie des romanciers
russes du XlX-me siecle,
Ossip-Lourie 158

Role du sel en therapeutique,
le, Ch. Achard 54

Semeiotics and diagnosis of
mental diseases, their treat-
ment and handling, Serge
Soukhanoff 160

Simulacion en la lucha por la
vida, la, Jose Ingegnieros . . . 112

PAGE

Studi sulla pazzia nella pro-
yincia di Roma, confronti
internazionali, Augusto Gian-
nelli 204

Studies in the physiology of
sex. Sexual selection in man.
1, Touch. 2. Smell, 3, Hear-
ing. 4, Vision. Havelock
Ellis 107

Syndrome de la nevrose ascen-
dante (nevrite ascendante
regionale). Clinique et ex-
perimentation, le, J. A. Si-
card 207

Trattato di psichiatria ad uso
dei medici e degli studenti,
Leonardo Bianchi 52

Tuberculosis as a disease of the
masses, and how to combat
it, S. A. Knopf.... 56

Variazione dei sulchi cerebrali
e la loro origine segmentale
neir hylobates, Sergio Sergi. 56

Youth of Washington told in
the form of an autobiog-
raphy, the, S. Weir Mitchell. 55

CONTRIBUTORS OF ORIGINAL PAPERS

CERLETTI, DR. UGO, Italy.
LUCANGELLI, DR. LUCA

GIAN, Italy.
PERUSINI, DR. GAETANO,

Italy.
ROBINOVITCH, DR. LOUISE

G., New York.

SAMBALINO, DR. L., Italy.

SANTE DE SANCTIS, PROF.,
Italy.

SERGI, DR. SERGIO, Italy.

TIMPANO, DR. PIETRO, Italy.

VOROBIEFF, DR. V. V.,* Russia.

*Killed during the recent riots at Moscow.

ILLUSTRATIONS

Respiratory curves and cardio-
gram during electrocution with an
electric current of low tension.
Mode of resuscitation.

Neurofibrils. Serial sections il-
lustrating the pathology of the neu-
rofibrils.

Cardiograms and respiratory

curves during sleep induced with
an electric current of low ten-
sion.

Serial sections illustrating the
anatomo-pathology of the thyroid
gland in a cretin dog.

Myograms illustrating reflex and
automatic excitability.

The Journal of Mental Pathology.

Vol. VII. 1905. No. 1.

HEREDO-SYPHILIS. FORM-INFANTILE
MULTIPLE SCLEROSIS.

(Familial Sclerotiform Heredo-Syphilis.)

{From the Laboratory, School for Backward Children,

Rome, Italy.)

By Prof. Sante De Sanctis and Dr. Gian Luca Lucangeli.

By the term multiple cerebro-spinal sclerosis, focal sclerosis
or sclerose en plaques is designated a special morbid entity char-
acterized by special sclerotic processes of the central nervous
system. Charcot described the symptomatology of the disease
and pointed out that it appeared either in a typical or in an
abortive form. Among the most important symptoms described
by him are intentional tremors, staggering gait, spastic paresis
of the limbs, contractures, exaggeration of the deep reflexes,
scanning speech, nystagmus, transitory emblyopia, papillary
atrophy, mental enfeeblement, epileptiform and apoplectiform
attacks.

This disease is not very common, not even in adults, forming
about 4% of all the nervous cases handled in clinics and dis-
pensaries. The percentage of these cases was discussed at a meet-
ing of the New-York Neurological Society, held February 4,
1902, and the results are shown in the table on the following page.

2 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

Number of cases.

Nervous Multiple

Authors. diseases, sclerosis. %

Dana, private clinic 3000 10 0.33

clinical histories 600 2 (*) 0.33

Hammond, private clinic. 3000 15 0.50

clinical histories 7000 32 0.50

Allen Starr 10056 27 (*) 0.27

Sachs 2000 13 0.65

Fisher, in six years 245* 10 (*) 0.41

Collins, 1890-1897 4000 28 0.70

1898 1270 3 0.24

1899 1400 5 0.36

1900 1368 5 0.36

1901 1470 5 0.34

Total 37615 155 0.40%

According to Spiller, multiple sclerosis is more common in
Europe than in the United States, and according to Sorgente, —
more common among men than among women. Moncorvo, on
the contrary, considers the disease more common among women.
Among children the disease is so rare of occurrence that some
authors even question its existence at that age. In children, ac-
cording to Westphall, the question is simply that of pseudo-scler-
osis ending in recovery, and when autopsies are obtained ao
lesions are found. According to P. Marie, multiple sclerosis
never affects children, and the reported cases in children are
always those of hysteria or cerebral sclerosis. The youngest
case, — that reported by Pollak, was that of a child five months
old. According to Grasset, it is rare to find a case of multiple
sclerosis in children under seven years of age. According to
Leiden and Goldscheider, the disease is most frequently met with
after thirty years of age, and generally speaking between 18 and
35 years of age. The first case of a child was reported by Schuele,
in 187 1 ; other cases were then reported by Deschfeld, Bristowe,
Ten Cate, Hoedemaker, and others. Until 1878, however, cases
of infantile multiple sclerosis were still rare in literature (Erb).
According to P. Marie, there were only 13 infantile cases reported
up to 1883. The latter author doubted the authenticity of some of
those diagnoses, so that in 1886, Grasset claimed that only a few
of the juvenile cases could be accepted as such. According to
Unger, there were 19 infantile cases reported up to 1887, and in
1889, they numbered 39. Stieglitz reduced that number to 35.
(*) Some of which are dubious.

HEREDO-SYPHTLIS — Prof. De Sanctis and Dr. Lucangeli. 3

In 1892, Mensi collected 26 cases in all (19 reported by Unger
and 7 by Nolda).

In 1900, D'Espine and Picot claimed that there were only some
thirty positive cases, and in the review of the 37 cases by Sorgente,
only 3 are accompanied by post-mortem documentation (the cases
of Eichhorst, Zenker and Schuele). In 1902, there were, accord-
ing to Schupfer, 58 cases, of which only 26 were positive ones.
To-day there are some 59 cases. The rarity of the disease is ad-
mitted by all neurologists. Jelliffe, for instance, found 9 among
109 nervous cases, and Bourneville, during a period of 20 years,
found 4 cases at Bicetre.

From what has been said above it is seen that infantile multiple
sclerosis is a rare disease, and that many of the cases reported
in literature are dubious as to their being those of infantile mul-
tiple sclerosis. Struempell, Sachs and others say that in children
the diagnosis of multiple sclerosis is doubtful if not verified by an
autopsy.

We should finally ask ourselves whether there is a familial
form of multiple sclerosis during infancy. There is not only a
hereditary (Eichhordt, Klausner) but also a familial form.
Some such cases have been published (Frerichs, Carini, Abraham-
son, Moncorvo, Friedmann, Deschfeld, Cestan and Guillaine,
Pelizaeus, Reynolds, Massalongo, Friedreich, Erb and Totzke)
but they are not quite positive. So much so that Abrahamson
remarks in his case that its being familial speaks against the
diagnosis of multiple sclerosis. Even if one does not admit the
above assertion as being quite exact, it remains certain, never-
theless, that such familial forms that have been published under
the name of multiple sclerosis lack not only in anatomo-path-
ologic (*) but also in ophthalmoscopic findings. The latter find-
ings, as we shall see below, are of considerable importance. We
insist on this point because familial cases that presented even a
typical symptom-complex of multiple sclerosis were proven by
the course of" the disease and the autopsies to have quite dif-
ferent lesions.

Schupfer, who seeks to give the clinical signs of true infantile
multiple sclerosis (a useful endeavor if there existed truly path-
ognomonic signs) says himself, with various other authors, that
many other nervous affections run their course, presenting the
clinical symptoms of multiple sclerosis. This fact should par-
ticularly be borne in mind when dealing with familial forms.
Thus, one is apt to be led astray in cases of Friedreich's ataxia,

* It seems to us inconvenient to have to wait for the autopsy in order
to make a clinical diagnosis.

4 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

Westphall's pseudo-sclerosis, essential hereditary tremor, cere-
bellar ataxia (Marie's type), cerebellar atrophy with degeneration
of the pyramidal tracts (Popoff, Bourneville and Crouzon),
hystero-organic associations (Raymond), spastic paraplegia and
diplegia (Pelizaeus, Freud, Sutherland), lobar cerebral sclerosis
(P. Marie), myelitis with secondary degeneration (Sorgente),
spastic tabes of Erb and Charcot (Araoz-Alfaro), Little's dis-
ease (Naef, Pineles). Freud and Marie advise to reject the
diagnosis of multiple sclerosis even if there is only one symptom
of Little's syndrome present. Schupfer, however, considers the
above restriction excessive, and the symptoms are so classed that
multiple sclerosis and cerebral spastic diplegia may be differ-
entiated respectively. Even arrest of development of the cerebral
nervous system (Pesker, Pelizaeus, Sachs — agenesis corticalis)
and cerebral tumors may simulate multiple sclerosis (West-
phall) ; finally, some forms of poisoning, — hysteria (Terrien,
Charcot, Raymond, Sabrazes and Cabanes), malaria (Torti and
Angeli), chicken-pox and whooping-cough (Variot, Barthez and
Sanne).

Thus, we should admit that more than one true morbid entity
that can be brought under the term of multiple sclerosis may
often have to be differentiated from sclerotiform syndromes that
may be due to many and various morbid processes. Among
those, it seems to us, hereditary cerebrospinal syphilis merits
particular attention. In 1886, Fournier first claimed that heredi-
tary cerebral syphilis had no special symptomatology character- -
istic of itself and that all phenomena with which it presents it-
self were characteristic of many common forms of encephalopathy
and even of all possible forms of encephalopathy of whatever na-
ture. Besides, in his work on hereditary syphilis, he devoted a
whole chapter to the consideration of multiple sclerosis, remark-
ing that theoretically he had long since considered this disease
as an affection in which syhilis should some day be given a most
prominent part as a cause. He further added that while it had
been difficult for him to demonstrate that view clinically and
anatomically, Moncorvo had demonstrated its validity. In 1884,
the latter author claimed that hereditary syphilis was the cause
of multiple sclerosis in some instances. He supported his con-
clusion by a complete and masterful study of three cases, showing
that multiple sclerosis had, without any doubt, been developed
during childhood (between 7 months and 10 years of age), the
children being decidedly affected with hereditary syphilis. The
pathogenesis is confirmed both by clinical findings and the un-
deniably favorable effects produced by specific treatment. It is

HEREDO-SYPHILIS— Prof. De Sanctis and Dr. Lucangeli. 5

evident that these authors did not make any distinction between
true sclerosis and the sclerotiform diseases, thus admitting a form
of multiple sclerosis of heredo'-syhilitic nature.

The autopsies reported by Cruveillhier, Daniel, Mollier, Vir-
chow, F. Dreyfus and others, demonstrate that the brain can be
directly affected by hereditary syphilis. In those cases were found
acute and chronic meningitis and cerebral lesions developed un-
der the influence of these causes. In 1893, Foa, in Italy, pub-
lished an autopsy performed on a child, whose clinical history had
not been known. He found sclerosis and aplasia of the cerebral
convolutions that were hard and whitish ; there were also dis-
seminated sclerosis focuses in the corpus striatum, optic thalamus
and medulla. Besides, gelatinous gommata were found in the
heart and the cortical substance of the kidneys ; there v/as no
trace of lesion in the bladder. Forms of familial spastic paralysis
due to hereditary syphilis have been described by Filatow, Jacob-
son and Homen.

According to Leyden and Goldscheider, multiple sclerosis is
characterized by scanning, nystagmus and tremors, as distin-
guished from hereditary syphilis that is characterized by pareses
of the cranial, nerves, hemiplegia and dementia, adding, however,
that the differential diagnosis is very difficult to make. Redlich
and Hoffmann are of similar opinion, saying that the only pos-
sible diagnosis is that based on anatomic findings. According
to Sachs, Oppenheim, Soltas, Cassirer and others, syphilis in the
adult may bring about disseminated sclerosis. Something similar
is also found in heredo-syphilitic children. The symptomatic
similarity as above does not authorize to state, however, that the
anatomic lesions are similar to those found in mutiple sclerosis.
Here, as well as in the familial forms of Moncorvo, one can
speak only of syphilitic disseminated sclerosis, while the anatomic
findings differ from those of true multiple sclerosis (Schupfer).
Schupfer ascribes little importance to heredity in multiple scle-
rosis, indicating as characteristics of multiple "sclerosis with
heredo-syphilis — vesicular disturbances and those of general
sensibility, the progressive course (although periods of temporary
improvement are possible) and a duration of many years' stand-
ing. We think, however, that the distinctive traits between true
multiple sclerosis and multiple sclerosis or sclerotiform diseases
due to heredo-syphilis are the course of the disease and the ocular
disturbances.

The course of true multiple sclerosis, as we have already men-
tioned, is progressive, and the prognosis is always bad (Charcot,
Struempell, Schupfer, Freud). In the heredo syphilitic forms,

6 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

on the contrary, especially in cases subjected to energetic specific
treatment, the course is regressive and the prognosis is quite fa-
vorable: marked improvement may be obtained (our cases) and
quite often complete cure is possible (Moncorvo, Mensi, Sor-
gente). Of the ocular disturbances — the characteristic trait of
true multiple sclerosis — optic neuritis with white papillary atrophy
is noted. This condition is readily seen with the ophthalmoscope :
the pale or white papilla is like porcelain, with well defined mar-
gins and bowl-shaped excavations, atrophy of the nervous fibrils,
leaving bare the lamina cribriforma, and the vessels, reduced in
volume, are filiform. The ocular lesions in heredo-syphilis are
quite different: even if the various forms of gommatous or dif-
fuse neuritis of the Ill-d, IV-th and Vl-th pairs of cranial
nerves, and their respective manifestations (Esmarch, Jossen,
Lancereau, Virchow, Wagner, Westphall, Heubner, Rumpf)
are absent, and even when the different forms of inter-
stitial keratitis are absent (Hutchinson) (*) the differential
diagnosis can be made on the basis of the ophthalmoscopic find-
ings : sometimes the eye-ground is found normal, but most fre-
quently the characteristic specific choroido-retinitis is found either
in its early or mature stage. This is accompanied by Foerster's
yellow atrophy and the well familiar reddish nodules due to the
choroiditis. These nodules are paler as the part considered is
farther from the centre, finally ending in a fringe of black pig-
ment. Optic neuritis of multiple sclerosis has been well described
by Parinaud, Uthofr, Gunther, Nagel, Lubbers, Zunn, Schwarz,
Eichhorst, Charcot, Oppenheim, Acqaderni (Dr. Nigrisoli's re-
port), Sorgente (Prof. Fortunati's report, Rome). Bruns and
Stoeling have found atrophy in 30% of the cases of multiple
sclerosis, Sachs found complete atrophy in 3% and incomplete
in 5% of his cases. He adds that atrophy of the temporal half
of the papillae is almost pathognomonic. Schupfer also attaches
much importance to this atrophy, and justly so. Generally
speaking not all authors who have come across this variety of
atrophy have attached to it as much importance as it merits, ac-
cording to us. Besides, many authors have omitted the ophthal-
moscopic examinations in their papers. According to us, the
optic neuritis is a sign of the utmost value in true multiple scle-
rosis. Besides, when the disease is of a progressive course, the

* The frequency of the ocular forms in heredo-syphilis can be seen
from Fournier's statistics that follow :

1. Ocular affections 101 cases.

2. Osseous affections ... I 82 cases.

3. Cutaneous affections , S3 cases.

4. Pharyngeal affections 46 c^ses.

5. Cerebral symptoms 42 cases.

HEREDO-SYPHILIS— Prof. De Sanctis and Dr. Lucangeli. y

above sign is the only one that enables to differentiate between
true multiple sclerosis and the sckrotiform affections, especially
those of heredo-syphilitic nature.

The cases of three members of the same family, two brothers
and one sister, cited below demonstrate our statements.

Family B. The father is healthy, greatly addicted to the use
of alcoholic drinks. According to various physicians who have
had him under their care, he contracted syphilis and had had
syphilitic eruptions before he was married. He denies, however,
having had syphilis. The mother is of robust health but of low
intelligence. The first child, a boy was born after a difficult
confinement. He died, 13 days of age, of "paralysis" (?). The
family physician said that the child died of syphilis inherited from
the father. Two abortions followed the first childbirth, and then
our three patients, R-do, A-do and F-ta were born ; the last child,
A-se, is healthy. It seems evident that the health of the de-
scendants of this family improved as time went on. As we have
stated :

The first child died, 13 days of age.

The second conception ended in abortion.

The third conception ended in abortion.

The fourth child, R-do, is ill.

The fifth child, A-do, is ill.

The sixth child, F-ta, is ill.

The seventh child, A-se, is healthy.

Case I. — R-do, 10 years of age (1904). He was born at full
term, the delivery being normal. He was in good condition and
well fed until he was 5 months old. At that period he began
to hold his head inclined and to squint (strabismus). He also
began to lose flesh, improving or getting worse at different times.
He began to walk when three years of age, making little progress
in walking until he was 4 years of age. He has had measles,
then typhoid fever. The first four teeth were regular, but soon
decayed and fell out. He first said "mamma" when three years
old. The parents state that R's physical and mental development
was slow and irregular. Besides, he has always had a bad tem-
per, was rebellious and unmanageable. He was repeatedly re-
fused admittance to school and was finally placed in the Asilo-
Scuola, October 5, 1899.

Objective Examination, June i, 1900. — The patient is 6
years of age. Weight, 15.500 kilogs, height, 96.5 cts., maximum
extension of the arms, 93 cts. The head is ovoidal, slightly
asymmetric, voluminous, of rachitic type, the maximum longi-
tudinal diameter being 175 mm. and the maximum transverse

8 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

diameter, 132 mm. The forehead is narrow, protruding, show-
ing marked furrows. The eye-balls are deep-set, the nose some-
what flat at the root, short and thick, the lower jaw heavy and
some teeth have fallen out decayed.

Nutrition. — The patient is voracious, his sleep is profound,
disturbed by nightmares. He is well nourished, however, and
the thyroid body is only slightly developed.

Motility and Sensibility. — The head is generally somewhat
inclined towards the right shoulder. Both during repose and
motion there is slight facial asymmetry due to insufficiency of the
left facial nerve. The superficial reflexes are not marked, the
patellar reflexes are difficult to obtain because the lower limbs
are insufficiently relaxed. When obtained, however, this reflex
is marked and rapid. The plantar reflex is torpid. Babinsky's
sign is absent. Muscular tonicity is augmented in the lower limbs.
In the oculo-motor sphere is noticed now incomplete abduction,
now convergent strabismus and nystagmus. A few years ago,
R. was left-handed, acting as if the right-hand had been too weak.
At present, the muscular force is poor in both hands. Slight
oscillatory tremor in the hands when extended and intentional
tremors in both hands. Spontaneous active movements are ac-
complished slowly and often with marked difficulty. Gait uncer-
tain, steps unequal or hesitating. Scanning speech. It is difficult
to determine the condition of sip'ht on account of the patient's
impaired attention. Hypermetropic refraction in both eyes. The
patient cannot tell in words one color from another. Eye-ground
normal (Prof. Fortunati examined the eyes). The patient can-
not differentiate the four principal tastes, designating them all as
"agreeable." He distinguishes agreeable from disagreeable
tastes, but cannot express the distinction in words. Tactile sen-
sibility is unimpaired in the entire body. Repeated tests with
Weber's esthesiometer show that localization of tactile sensibility
is also quite normal. Sensibility of pain is rather obtuse : feeble
reaction to pricking of the hands and face, more marked reac-
tion in the calves of the legs. Sense of position (muscular sense)
exists in the limbs, but not in the fingers. Visceral and cenesthetic
sensations feeble.

Psychic Condition. — Retarded and torpid attention. Ac-
centuated mobility of attention. Memory, feebly developed. No
capacity for arithmetical figuring. The patient becomes readily
angry, does not like companions and is selfish. He prefers to be
by himself, talk to himself and be lazy rather than play with
companions. He has no sense of order, is taciturn and apathetic.

Clinical notes, 1900, and winter of 1901. — The physical and

HEREDO-SYPHILIS— Prof. De Sanctis and Dr. Lucangeli. g

pedagogic treatment are giving favorable results. The patient's
general health, character and speech are improved. Chronic
rhinitis improved under iodide and iron treatment. January 30,
1 901, it was noted that there was marked improvement in speech.
The patient's aunt had noticed herself that the patient was now
more observant and alert than formerly. He made progress in
reading, writing, arithmetic and speech, but none in manual train-
ing, as the motor power of the hands remained impaired.

1901-1902. — R. has had to be away from the Asilo-Scuola on
account of disease, nevertheless, some improvement is noticed in
his speech and muscular force of the hands. The figures below
show the record with Collin's dynamometer, small model.

Right hand, 6, 6, 4, 3, 4. Average, 4.6 kilogs.

Left hand, 4, 2, 3, 2, 3. Average, 2.8 kilogs.

During the dynamometric measurements the patient's cheeks
become colored, at times he bites the lower lip and there are
tremors of the angles of the mouth, chin, eye-lids, brows and
even of the whole body. With Sandow's dumb-bells (modified
by De Sanctis), the patient makes 11 exercises with the right
hand, 3 of which are incomplete, and 5 with the left hand, — all
incomplete. Mathieu's pneumo-dynamometer registers 155. Re-
gardless of all the progress, R. remains rather torpid intellectual-
ly, showing a marked disposition to indolence. Tonic treatment
is continued.

1903.— Improvement in speech and movements. Attention and
conduct also show progress. The patient is not refractory to
moral education. He is classed as hypomoral-hypoesthesic.

Electric treatment has been tried (32 sittings with a galvanic
current), but the result was negative. Better results are ob-
tained from medical gymnastics. The patient can now perform
quite correctly the usual exercises. Flexion and extension of
the arms are readily performed. Flexion of the chest is well
done forward and laterally, but the patient' loses his equilibrium
when flexing backward. Gait is regular, but in the exercises
the lower limbs act with less certainty than do the upper ones.
The chest and head always remain inclined forward. In turning
or jumping- off a bench, R. loses his equilibrium and falls. De-
cember 12, 1903, the dynamometric measurements were as fol-
lows :

Right hand, 6, 7, 4, 4, 5. Average, 5.2 kilogs.

Left hand, 6, 4, 5, 3, 4. Average, 4.4 kilogs.
Among the noticeable symptoms are scanning speech, nystag-
mus, alternate strabismus and intentional tremors. Psychically,
there is intellectual and affective torpor.

10 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

Summer, 1904. — The physical development goes on with cer-
tain irregularity, as is seen from the figures below:

Date. Weight. Kilogs. Height. Ctms.

October 7, 1899 i5-5oo 96.5

December 12, 1902 24.700 121. 5

September 17, 1903 28.600 122.5

February 17, 1904 29.300 I24-5

April 8, 1904 28.600 124.7

June 15, 1904 27.500 125.0

August 17, 1904 27.800 125.0

October 31, 1904 28.600 126.0

Even the dynamometric measurements show curious irregu-
larities. For instance, February 17, 1904, right hand 5.8 kilogs,
left hand 5.2 kilogs; while June 17, 1904, average for left hand
4.8, for right hand 4.2.

This year the progress has been noticeable. The patient can
read and write according to requirements in his grade and can
make simple arithmetical additions, such as 2 plus 2, 3 plus 3,
etc., up to 100 ; he can also make similar simple subtractions.

Objective examination September 2, 1904. — R. looks well, but
has marked swelling of the left sub-maxillary glands. The head
is always inclined, as if the muscles of the neck were too weak
to sustain it. The superficial reflexes are accentuated, while the
deep reflexes are difficult to obtain and are perhaps impaired.
At times there is a slight degree of Babinsky's sign, but with
foot-clonus. The pupils react well to light and accommodation.
The vascular reflexes are normal. Slight paresis of the left
facial nerve : the left naso-labial fold is less marked than the right
one. The orbicularis muscle is also insufficient. Alternate stra-
bismus, slight rotary nystagmus. Prof. Puccioni's ophthalmo-
scopic examination showed nothing of note in either eye, except
marked pigmentation of the choroid in the external half. Rotary
nystagmus of both eye-balls, especially when a strong light is
thrown on them. Oscillatory tremors of the hands when ex-
tended and intentional tremors. Slight hypertonia in the lower
limbs. Absence of Romberg's signs. When made to walk on a
straight line traced on the ground, the patient loses easily his
equilibrium. There is always marked scanning in speech. At-
tention is torpid, but not very shifting. Memory is poor. Ability
for arithmetical figuring is quite satisfactory. Emotion in general
is little marked. With all the progress in his condition, the
patient remains backward in his mental and physical development.
Diagnosis. — Heredo-syphilis, form: multiple sclerosis (familial
sclerotiform heredo-syphilis).

HEREDO-SYPHILIS— Prof. De Sanctis and Dr. Lucangeli. Ir

Case II. — A — do, eight years of age (1904). Born at full
term, normal labor, nursed by his mother. According to the lat-
ter, "his tongue protruded from his mouth" until he was eighteen
months of age, and he was unable to hold himself straight until he
was two and a half years of age; even when seated, his body
was doubled up and his head inclined to the shoulder. Strabis-
mus was first noticed when he was five months old. He has had
whooping-cough and then bronchitis and pneumonia. He began
to walk late: when three years of age he dragged himself on
"all four, as if his legs had been too weak to hold him." Even
later, he never walked well. When three years of age, he had
pneumonia for the second time and measles. At that age he
could hardly say the simplest words. Even now he speaks
with difficulty, like his brother, R — do (bradylalia). Dentition
was regular. Towards six years of age he had neuroparalytic
ulcerative keratitis in both eyes, caused by syphilitic lesions of
the intracranial part of the trigeminus (diagnosis by Professor
Collica, who had treated the patient). The keratitis left leucomas
in both eyes. Intelligence was torpid. The patient has attended
a private school for the last two years, and we examined him
in the dispensary of the Asilo-Scuola.

Objective Examination, September 5, 1904. — Weight, 18.00
kilogs; height, 113.5 ctms. ; maximum extension of the arms,
1 10.5 ctms. ; cranial circumference, 510 mm. ; maximum longitudi-
nal diameter, 189 mm. ; maximum transverse diameter, 135 mm.
Cranial shape ovoidal with marked parieto-occipital sphere. The
ears are slightly ansated, forehead narrow and protruding, nose
somewhat flat at the root, short and thick. The jaw is moderately
prognathous.

General nutrition deficient. Voraciousness. The organs of
vegetative life normal. Sleep good. The patient dreams little
and does not remember his dreams.

The Motor Sphere. — General torpor and marked difficulty in
spontaneous movements. Facial mimicry very feeble. Super-
ficial reflexes normal. At times Babinsky's sign is obtained.
Deep reflexes obtained with difficulty and are feeble. Pharyngeal
reflexes normal. Pupillary reflexes difficult to obtain on account
of the leucomas. Resistance to passive movements marked, espe-
cially in the lower limbs. Lateral and rotary nystagmus. Per-
manent divergent strabismus. As has been remarked, this had
existed before the onset of the ulcerative keratitis. Insufficient
abduction of the left eye. Marked insufficiency of the right facial
nerve. The patient is left-handed, and movements with the right
hand are performed with some difficulty. Gait ataxispastic.

12 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

Marked oscillations of the body when in the Romberg position.
Loses his equilibrium when made to walk on a straight line
traced on the ground. Oscillatory tremors in the hands when
extended and slight intentional tremors. Slight athetoid move-
ments of the right hand. Dynamometric measurements (Col-
lin's small model) as follows:

Right hand, 4, 2, 3, 2, 3. Average, 2.8 kilogs.
Left hand, 4, 5, 4, 3, 3. Average, 3.8 kilogs.

The right hand is particularly weak.

A— do speaks slowly, pronouncing words syllable by syllable,
and scanning in speech is marked.

The leucomas are not central in either eye, but almost so.
Visits Y^. Cannot distinguish by words one color from another.
Professor Puccioni's examination: in both eyes — diffuse, inter-
stitial (parenchymatous) keratitis of syphilitic origin prevents
making an ophthalmoscopic examination. Mydriasis of both pu-
pils. They do not react to light, as they are under the influence
of atropine. The patient does not distinguish the four principal
tastes, all being "agreeable" to him. Gustatory, cutaneous, vis-
ceral and cenesthetic sensations impaired.

Psychic Sphere. — Attention is readily attracted, but concen-
tration is wanting. Curiosity is marked. Memory and capacity
for arithmetical figuring poor. Poor emotiveness in general.
Tendency to be by himself ; torpid, apathetic, but of good conduct.

Within the last few years the child has been improving spon-
taneously, without any treatment.

Diagnosis. — Heredo-syphilis, variety: multiple sclerosis (fa-
milial sclerotiform heredo-syphilis).

Case III. — F — ta, six years of age ( 1904). The child was born
at full term, after a normal labor. She was nursed by a wet-
nurse. Has never had any convulsions. Began to walk when
five years of age. Marked delay in learning to speak. Dentition
regular. First showed muscular enfeeblement between four and
five months of age. Difficulty in holding her head in desired
positions or in moving her eyes (strabismus), exactly as was
the case with her brothers, R — do and F — do. Had measles
when two years of age and typhoid fever when three years of age,
at the same time when her brother, R — do, was ill with it. After
that she was in comparatively good health. She has had bilateral
otitis with purulent discharges. She has always been a good
child, but torpid intellectually. She can say only a few simple
words. She has been attending a private school for the last two
years, but has not learned anything. Admitted to the Asilo-
Scuola April 12, 1904.

HEREDO-SYPHILIS— Prof. De Sanctis and Dr. Lucangeli. -, 13

Objective Examination, May 30, 1904. — Weight, 17,200
kilogs; height, 103.0 cts. Cranial circumference, 460 mm. ; maxi-
mum longitudinal diameter, 156 mm.; maximum transverse di-
ameter, 136 mm. Shape of head hydrocephalic, forehead pro-
truding, jaw markedly prognathous. Hutchinson's teeth. Thy-
roid body only slightly developed.

General nutrition good. General coloring pale. Enlarged
glands in the cervical region.

Motor Sphere. — The head is inclined towards the left shoul-
der. Frequent deviation of the eye-balls. Slight hypertonia
in the lower limbs. Preferably left-handed. Lateral and rotary
nystagmus. Marked intentional tremors. Patellar reflexes dif-
ficult to obtain. Right plantar reflexes seem good. Babinsky's
sign not obtained on the left side after several tests, but frequently
obtained on the right side. Impossible to obtain dynamometric
measurements because the child's hands are small and she cannot
squeeze the instrument. Besides, she cannot fix her attention on
the experiment. Alternate strabismus. Ataxi-spastic gait. It
may be said that the child's speech is entirely undeveloped. Sen-
sibility is normal. Vision (examination by Professor Fortunati,
October 29, 1904) : equal myopic refraction of both eyes ; impos-
sible to obtain the visual acuteness. Abnormal form of strabis-
mus with external and upward deviation of the right eye. There
is no secondary deviation, however, the left eye tending to slight
rotary movement downward. Ophthalmoscopic examination:
papillae do not present any traces of staphyloma ; on the left side,
however, there are some slight cicatrices of the choroid, dating
since intra-uterine life and being probably of syphilitic nature.

Psychic function undeveloped, the child being in a condition
of singular torpor, although she cannot reasonably be classed as
an idiot.

Summer, 1904. — Her physical condition is such that it inter-
feres with her receiving any training. It is still impossible to
obtain her dynamometric registration.

Autumn, 1904. — Muscular system little developed. Superficial
reflexes normal, pharyngeal reflexes exaggerated, pupillary re-
flexes normal, patellar reflexes difficult to obtain. Insufficiency of
the external recti muscles of the eyes, slight lateral and rotary
nystagmus. Insufficiency of the left orbicular and palpebral mus-
cles. The head is inclined towards the left shoulder. Slight hy-
pertonia of the lower limbs. Motility of the hands not yet de-
veloped. Impossible to study the specific sensibility on account
of the child's mental condition and her inability to speak. Ataxi-
spastic gait. Romberg's sign.

THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

Psychic Sphere, — Attention is provoked readily, but concen-
tration is wanting. Curiosity marked. Little emotiveness. Pre-
fers to be by herself. Sense of cleanliness and order relatively
well developed. Facial mimicry poor. She has been trained to
say some words (mam-ma, pa-pa), but scanning and bradylalia
are very marked.

She is taking iodide treatment and is being trained. No doubt
she will improve in a few months.

Diganosis. — Heredo-syphilis, form: multiple sclerosis (familial
sclerotiform heredo-syphilis).

summary of the three cases above described.

The symptoms common to all the three cases are as follows :
Slight insufficiency of the facial nerve.

For the present, the deep reflexes are weak and difficult to
obtain.

Torpid motility and hypertonia of the lower limbs.

Strabismus and nystagmus.

Intentional tremors.

Defective gait.

Scanning speech and bradylalia.

Arrest of development of speech.

Insufficient mental development.

R— do.

In 1900, patellar
reflexes quick and
marked.

Plantar reflexes
very torpid.

Absence of Ba-
binsky's sign.

Sometimes con-
vergent strabismus.

Slight oscillatory
and intentional tre-
mors.

Gait — irregular-
ity of steps, at
times vascillating.

Absence of Rom-
berg's sign.

DIFFERENTIAL SYMPTOMS.

A— do. F— ta.

Patellar reflexes always difficult to obtain
and feeble.

Plantar reflexes normal.

At times Babin-
sky's sign.

Permanent diver-
gent strabismus.

Evident oscilla-
tory tremors, slight
intentional tremors.

Gait slightly
ataxispastic.

Noticeable oscil-
lations in Rom-
berg's position.

sign
the

stra-

Babinsky's
frequent on
right side.

Alternate
bismus.

Marked inten-
tional tremors.

Gait markedly
ataxispastic.

Romberg's sign.

HEREDO-SYPHILIS— Prof. De Sanctis and Dr. Lucangeli. j$

In the cases considered above classic multiple sclerosis is quite
well simulated. It is easy to understand how different authors
would ascribe multiple sclerosis to syphilis, on the one hand, and
on the other hand claim the differential diagnosis between mul-
tiple sclerosis and cerebro-spinal syphilis to be sometimes im-
possible. When the symptomatology is carefully examined,
however, the difference is evident. According to us, it is not
reasonable to say that the differential traits of true multiple
sclerosis should be based on the anatomo-pathologic changes :
it is not necessary to wait for the autopsy in order to make the
diagnosis. What, indeed, is one to do as regards the diagnosis
when the patient improves instead of dying? We should strive
to ferret out the clinical characteristics that differentiate true
multiple sclerosis from the sclerotiform diseases.

Our conclusions are:

i. The nosographic entity of familial infantile multiple sclero-
sis lacks in certainty because the clinical examination in the cases
published is insufficient.

2. It is necessary to differentiate between multiple sclerosis
and the sclerotiform diseases of the nervous system.

3. It may be asserted that there exists a sclerotic form of cere-
bro-spinal heredo-syphilis and that this form is of frequent occur-
rence during infancy. According to us, this form should never
be confounded with true multiple sclerosis, — on the basis that
heredo-syphilis may be the cause of this disease.

4. Differential symptoms are always found when looked for.
According to us, the course of the disease and the ophthalmo-
scopic findings are of the utmost importance.

5. A case of infantile multiple sclerosis, of the familial type,
lacking an accurate ocular examination and that has not been
under observation for a sufficiently long period of time should
not be accepted as being of statistical value.

Rome, Italy, December 26, 1904.

r6 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

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HEREDO-SYPHILIS — Prof. De Sanctis and Dr. Lucangeli. 19

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CLINICAL OBSERVATION ON A RARE CASE

OF "PHOBIA."

By Dr. Pietro Timpano.

Medical literature is certainly not poor in cases of "phobias",
but the study of their origin, development and clinical varieties
still remains interesting. I have had occasion to study a unique
and interesting case of "phobia" that I relate in this paper.

M. M. is 33 years of age, married and has children. Her
father died of heart disease at the age of 60 years. Her mother
is living and healthy. Five brothers and sisters are living,
healthy, and have never had any disease worthy of note. Three
brothers and sisters died during infancy from artificial feed-
ing. The mother of the patient, while pregnant with the latter,
had not had any infections or other disease, and the confinement
was normal. There were no traumatisms, infections or unusual
emotions during this pregnancy. There is no morbid heredity
either in the ascending, descending or collateral branches of the
family.

During childhood, the patient had measles. She was normal
in every respect as a child and young girl. She was good natured,
intelligent and interested in her studies and household duties.
She married when 19 years of age. Eight months later she
had an attack of acute gastro-enteritis but soon recovered from
it. After her first confinement she again had an attack of
gastro-enteritis that was probably of infectious nature. She
soon recovered from this second attack also. During her conva-
lescence from this attack she tried to pass the time by reading
the life of St. Louis. After a few minutes' reading of this
book, however, she felt faint and had several spells of vomiting.
The patient had been very careful with her diet, but after this
spell she had another attack of gastro-enteritis. She blamed
herself for having exerted herself in reading, considered the
latter as the cause of her present illness, and thereafter abstained
from reading any more books. Within the course of a week she
recovered from this new spell of gastric disturbance and re-
sumed her household duties. Two months later, one of the pa-

22 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

tient's friends insisted on her reading "Quo Vadis?" The pa-
tient tried1 to read the book, but a strange feeling of aversion
possessed her. She made every effort to get over this strange
and unwarranted feeling, but it was in vain. Every time she
looked at the printed pages she experienced a sensation of op-
pression and malaise. This peculiarity was not limited to printed
matter, however; she also found it irksome to read letters that
came through the mails. This aversion was not accom-
panied by cephalalgia, weakness, vertigo or vomiting. The pa-
tient suffered from this pecularity for 13 years before she
came to my notice. When explaining to me her actual condition,
she said: "Whenever I make an attempt to read anything I
am overcome by a fear that vomiting should set in and make me
ill; even in church I abstain from reading during service and it
makes me feel ill to see others read".

Objective examination. — She did not complain of any other
disturbance. The conformation of her skeleton was normal, the
muscular system and adipose tissues normal, and the color of
the skin normal. She was of normal height, well formed and
the general nutrition was good. The face and cranium were
normal in aspect and measurements. The neurological examina-
tion showed: slight tremors of the fingers when the hands were
extended, the muscular force was normal, the reflexes normal,
the visual field normal on both sides, and motility was normal.
Tactile, thermic and dolorific sensibilities were normal. The
specific sensibility was also normal. Aside from the disturbance
examined here, the psychic examination was negative. Con-
sciousness was clear, attention ready and responsive, perception
was normal, there were no illusions or hallucinations, and memory
was normal. The patient was of a gay disposition, altruistic and
her religious sentiments were marked. She was rather emotional.
Her will-power was well preserved. She did not present any
abnormal impulses or perversions of the instincts.

So far as I know, there are no similar cases reported in medi-
cal literature. The only case that resembles mine is that de-
scribed by Battistelli. His case is as follows below.

X. X., a civil engineer, 52 years of age, married and having
children, is a descendant of a distinguished family. The heredi-
tary history is negative, both in the direct and indirect line.
The patient had typhoid fever when 16 years of age, and
his nervous system had suffered from this affection : during con-
valescence he had had several epileptiform attacks. After the
full establishment of convalescence, however, the attacks com-
pletely disappeared and never returned again. He graduated

A RARE CASE OF " PHOBIA "—Dr. Timpano.

from a University, taking his degree in the scientific department,
and then entered the business world, where, in the course of a
few years, he accumulated half a million lire. He then entered
in partnership with a firm in which he had to be bonded. He
gave his entire fortune as bond. In the course of time, the head
of the firm informed him that the business was ruined and that
the patient's entire fortune had been lost in various trans-
actions. This partner then made his escape to America. The
sudden shock of the misfortune and the escape of his partner
had shattered the patient's nervous system. Every day's mail
brought him an enormous number of" letters from creditors, and
the patient gave his personal attention to all of them.. The
nervous strain was intense, but he kept on reading his letters
unltil one morning he suddenly felt that he could not read his
correspondence: a deep sense of aversion prevented him from
reading his letters. He struggled with himself against this
sudden change in himself, but for several days the letters
accumulated without being read by him. His wife finally asked
him about the matter. He explained that Ithe shocking notes
he was receiving from the various business houses had completely
broken him down and that an awful aversion against reading
any of those letters prevented him from opening and reading
them. He then begged his wife to open and read them for
him. This fear of opening and reading letters persisted for
many years; it first took place in 1889, and was still present
when the case was published, in 1902. Whenever he had to open
and read a letter, his whole frame shook with emotion. When
it was absolutely necessary for him to read a letter, however, he
had to call into play all his force of will in order to succeed in
tearing the envelope open and read the letter.

The physical and functional condition of the nervous system
was normal. As regards the general sensibility, the patient
showed marked endurance ito physical pain. The special senses
were normal. The psychic examination showed the attention to
be good, perception rapid, intelligence well developed, culture
highly marked, consciousness clear, and he fully appreciated his
psychic disturbance. Memory was excellent. The patient was
highly emotional. Besides the disturbance here considered, how-
ever, the will-power was good.

From a clinical point of view the two cases in question are
of considerable interest. In Battistelli's case, X. X., there existed
"a morbid sentiment of emotion accompanied by some impair-
ment of the will-power." In my own case, M. M., we have
"emotiveness with markedly impaired volitional power".

24 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. *

What does X. do when he receives a letter? He holds it in
his hands and lacks the psychic force to tear the envelope open*.
A sinister current of thought disturbs has mind: the sealed
letters in his hands inform him of woeful events. When told
that his apprehension is unfounded, and he tries to tear the en-
velope open, he fails in the attempt. He is anxious to rid him-
self of his peculiar disturbance, of which he is fully conscious,,
but his anxiety is in vain.

M. is also anxious to rid herself of her psychic disturbance
of which she is fully conscious, but all her efforts in this direc-
tion fail to bring about the desired results. She is vexed by
the antagonism to her desire to tear the envelope open and the
failure to accomplish the act. The contrasts end in an "unsuc-
cessful volition" (Battistelli). The consciousness of this non-
success becomes the cause of the anxiety that accompanies the
"psychic contrast".

Both cases, then, represent two abulics or, better, partial
abulics with exaggerated emotiveness. These conditions in-
dicate the fundamental psychological bases upon which "phobias"
develop.

What is the clinical significance of the "phobia" in M.? Does
it represent a phenomenon of degeneration, neurasthenia or psy-
chasthenia? It is certainly important to properly diagnose cases
as regards the above points : the prognosis and treatment de-
pend on the diagnosis.

Formerly, "phobias" were considered as simple idees fixes or
as emotional manifestations caused by imperative conceptions.
The latter were said to affect both the ideation and the affective
sphere. According to Morel, for instance, a "phobia" is an
emotional delirium, exaggeration of emotiveness in relation to
an obsessional idea. Magnan considers "phobias" as manifesta-
tions of degeneracy. Tamburini is of similar opinion. Krafft-
Ebing says that "phobias" relate to degenerative forms with
neurasthenic bases. The etiology and symptomatology of the
"phobias," however, show that they differ with every case.
They should, therefore, be analyzed in their different forms : the
exclusively degenerative form, the neurasthenic form, and the
psychasthenic form.

To which of these forms does that of M. belong?

Considering the main characteristics of the three respective
forms, we find that in the degenerative form the important diag-
notic elements are: the physical, psychic and functional as
well as hereditary stigmata; the absence of the characteristics
of the neurasthenic forms; persistence and predominance of

A RARE CASE OF " PHOBIA "—Dr. Timpano. 2$

the psychic disturbance; the odd, superstitious and atavistic
nature of the incoercible idea, and the precordial uneasiness that
is often marked and prolonged.

In the neurasthenic form dyspeptic disturbances are marked;
there is insomnia, intellectual or physical fatigue after the slight-
est exertion, tendency to mentally exaggerate the intensity of the
trouble, loss of confidence in one's self, neurasthenic heredity,
etc., that generally accompanies "phobias". The latter are inter-
mittent in form and rather common-place in nature.

In the psychasthenic form the characteristics of one's own
personality are exaggerated; there is a tendency to pessimism,
false reasoning and the notions of the relation of cause and
effect are erroneous. The "phobia" is less tenacious and more
coercible.

Turning back to the case M., we find her history negative
both in the ascending and descending branches of the family ;
there are no psycho- or neuropathic disturbances, alcohol-
ism, tuberculosis or syphilis. The intra-uterine life of the
patient was normal. Her physical and mental development dur-
ing childhood were normal. Puberty and adolescence were nor-
mal. The anthropological examination showed nothing ab-
aiormal. The physiological and neurological examinations were
negative. Digestive, trophic, sensory, motor and reflex func-
tions— normal. Finally, apart from the disturbance under con-
sideration, the psychic examination was normal. Her main psy-
chic disturbance consists of a defective impulsive function in the
volitional sphere and of an accentuated emotiveness.

The clinical analysis of the case does not warrant our classing
her disease in the neuro- or psychasthenic groups. There was
no surmenage or any of the other fatigues that can point towards
neurasthenia. The only thing that can lead us in the diagnosis
of the case is the aspect and course of the "phobia".

In the neurasthenic form the "phobia" is generally less fan-
tastic than in the degenerative form. In the neurasthenic form
the "phobia" is also apt to be of periodic or intermittent onset,
not accompanied by any precordial oppression, as is generally
found in the degenerative form. There is noi characteristic in
the ''phobia" of M. to warrant its being classed in the psychas-
thenic group. The only group in which her "phobia" can be
classed, therefore, is the degenerative group. Yet the symptoma-
tology of her "phobia" does not justify this classification. Nor
do her hereditary and clinical histories warrant this classifica-
tion. Considering, however, that her "phobia" has lasted 13
years, that its aspect is absolutely absurd and superstitious, and

26 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. i

the fruitlessness of every attempt of the patient to conquer her
fear of reading a book or letter, seem to point to the degenerative
nature of the "phobia".

The case of Battistelli, X. X., is also of a degenerative nature.

How can one explain the existence of a degenerate constitu-
tion in the absence of all degenerative stigmata and in face of a
normal intra- and extra-uterine life ? In such cases one can only
suppose the existence of a latent psychic invalidity. In some cases
a physical or moral shock may readily bring to light a latent
psychic invalidity. Some cases, perfectly normal physically and
of perfectly normal psychic life, may have a latent psychic in-
validity that can be called out only by an extraordinary physical
or moral shock. From the standpoint of the prognosis, it is
important to take these points into consideration.

The prognosis in such cases should always be given with
some reserve. Generally speaking, subjects stigmatized with con-
genital psychiatric predisposition are not easily cured. Cases that
had passed many years of normal psychic life and suddenly pre-
sent some psychic disturbance may be given a more favorable
prognosis. One should always bear in mind, however, the de-
generative nature of the disturbance. The duration of the trouble
also has some significance : the shorter its duration, the better its
prognosis. An imperfect recovery may also be followed by a
return of the disease. If the remissions are frequent, the dis-
ease may finally become chronic.

The treatment in such cases is palliative. To the good hygi-
enic treatment should be added psychic treatment. The latter
is becoming more and more important. The. method of re-
education, advocated by Bernheim, Brissaud, Janet and others,
is considered of importance. Good food, rest and hygiene are
to be observed. Moral reasoning with the patient, showing
him the absurdity of his queer fears and the possibility of reach-
ing again one's normal condition are of value. Such treatment
may bring about marked improvement and even a cure.

Italy, November, 1904.

The Journal of Mental Pathology.

Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. VII. 1905. No. 1

STATE PRESS, Publishers,
New York.

MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.

Address bulky mail matter to P. 0. Box 1023, New York.

This Journal is published bi-monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.

Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope.

THE PHASES OF CONSCIOUSNESS FROM THE
MEDICO-LEGAL POINT OF VIEW.

Psychiatry and neurology have brought to light the fact that
subjects committing criminal acts while in a condition of ob-
scured consciousness are not responsible before the law. In
some of the civilized countries the law bows to this dictum of
the scientist. The irresponsibility of subjects committing crimes
during post-epileptic delirium, somnambulism and allied dis-
turbances, is accepted on the ground that the subject is uncon-
scious of his surroundings at the time of commission of his crime.
Up to a recent date, all clinicians were agreed on the point that
unconsciousness characterized all the acts committed during post-
epileptic delirium, somnambulism and similar disturbances. More
recent study of these affections tends to prove that consciousness
is not always totally obscured in these states. One of the most
recent papers on this question is that by N. Vaschide and P.
Meunier, entitled "Contribution to the Study of Mental Im-
pulses," published in this Journal (Vol. V, Nos. 4-5). According

28 EDITORIAL.

to the facts adduced in that paper, absolute loss of consciousness
is not a necessary accompaniment of what may be termed an
equivalent of post-epileptic delirium. In legal medicine, this
new point of view is apt to cause some difficulties as regards the
present point of view on responsibility for criminal acts com-
mitted during such delirium : while the law generally admits the
plea of irresponsibility in cases of criminal acts committed dur-
ing complete unsconsciousness, irresponsibility for similar acts
committed, of which remembrance remains, either during the
wakeful or the hypnotic state, is as yet a novelty in legal medi-
cine. Clinical facts tend to show, however, that we may look for
this new departure in legal medicine in the near future. That
excellent psychiatric clinician of Nantes, Dr. Biaute, recently had
occasion to appear before a legal tribunal and cause the release
of a woman who had killed her lover while in a state of somnam-
bulism. The case is published in Annates Medico-Psycho-
logiques, November-December, 1904. In the wakeful state, the
woman had absolutely no recollection of her deed, but Dr. Biaute
succeeded several times, in the presence of two other members of
the medico-legal commission entrusted to examine the case, in
making her enact the killing of the man in all the details that ac-
companied the reality. The patient was simply hypnotized,, and
during her hypnotic sleep she was told to enact the murder. Need-
less to say that simulation was out of the question here.

While cases like that of Dr. Biaute are exceptional, their ex-
istence should not be disregarded. The dearth of reports of
such cases is probably due to the lack of our understanding of
the various phases of consciousness and our consequent inabilitv
to recognize them when we see them. Now and then we report
and read of peculiar and unaccountable criminal acts apparently
committed in unconscious states, but we do not yet know how to
study them. The newer researches and discoveries are simplify-
ing our methods of investigation of the various phases of con-
sciousness. Striking cases like those mentioned above, and that
of Prof. Tschisch, entitled "Larval Epilepsy," published in this
Journal (Vol IV, page 34), seem to present an endless source
for the study of consciousness in its various degrees. The
medico-legal import of such study is obvious. Dr. Biaute lays
stress on the fact that absolute loss of remembrance of acts com-
mitted during somnambulism is not verified in all cases. This
fact he has demonstrated in his case mentioned above, in which
remembrance could be evoked during hypnotic sleep. He also
mentions the case related by dom Duhaget to Fodere, in which
the would-be murder of a friend was not remembered spon-

EDITORIAL. 29

taneously : — when questioned by the eye witness of the somnam-
bulistic act, the poor Jesuit admitted having dreamt a terrible
dream, — that he had killed his friend. He then related every de-
tail of that "dream," how he had plunged a dagger into his
friend's breast, etc. The friend was himself the witness of the
entire scene and escaped being killed simply because he hap-
pened to be out of bed.

In the instances related above it seems that acts committed
during post-epileptic delirium, or what seems to be its equivalent,
and somnambulistic states, may be remembered by the subject
in various conditions of consciousness and with various vivid-
ness of memory, respectively. A thorough study of these
phenomena would elucidate some clinical as well as medico-
legal questions.

THE NEWEST CONCEPTION OF CONSCIOUSNESS AND

WILL-POWER.

Under the heading of "Les illusions des psychologues" Prof.
G. Sergi publishes a striking paper in Archives de Psychologic
(November, 1904). He says that the terms "consciousness" and
"will-power" are relics of ancient language and do not corre-
spond to the states we mean to express by them — because those
states do not exist. Consciousness is nothing in itself ; it is
neither a substance, a quality nor a condition of what is called
the soul. Consciousness, he says, is simply a revelator of phe-
nomena that are brought into play and succeed one another with-
out intention or activity on our part. When one is thinking pas-
sively, it is not consciousness that is manufacturing his thoughts ;
the latter display themselves by a different process, and con-
sciousness is simply the revelator of the thoughts ; besides, this
revelation is not always a necessary accompaniment of cerebra-
tion. The phenomenon of thinking is similar to all other phe-
nomena of activity in nature. The mechanism of thinking may
be compared to that of respiration, or the cardiac function. In
nature no activity develops spontaneously. Every activity in
nature is brought into play by an action external to itself. The
rhythmic, continuous and incessant action of respiration and
cardiac beat, for instance, are automatic acts (although some
physiologists consider them reflex) that have their origin in
causes external to themselves. In respiration, the entrance, of
air into the lungs of the new-born starts the respiratory activity
that lasts during the individual's life-time. The first impulse of
the cardiac vesicle is not quite as easily explained, but the princi-
ple remains the same as in that of respiration : there is an initial

EDITORIAL.

external force, but never a spontaneous one. The same principle
is also applicable to the mechanism of thought: every thought is.
brought into play by an external impulse that is called in psych-
ology suggestion. The various forms of suggestion, such as
words, visions, sounds, odors, etc., constitute the external im-
pulse to mentalization both in the normal and abnormal subject.
Consequently, cerebration is a passive act in which conscious-
ness does not participate, but simply reveals to us what is going
on in our brains. The same mechanism is applicable to so-called
active or creative cerebration: the writing of a book, etc., is
enacted through the external impulses crowded in our minds.
The suggestion that the various thoughts present to us provokes
mental activity without there being any participation of con-
sciousness. The act of thinking, therefore, is unconscious, but
the representation of thought may or may not be conscious. We
and our consciousness are only passive spectators of the mental
phenomena as we are passive spectators of other physiologic vital
phenomena enacted within us.

When the psychologist and psychiatrist speak of responsibility
or non-responsibility of individuals, because they enacted
thoughts that were conscious or unconscious, those scientists lay
down their dogmas on the ground of an illusion in science.

The accepted conception of will-power is also an illusion. If
we perform an act, it is not because we will to act but because an
external excitation calls out the response in the form of that act.
When inanimate objects react, they are not conscious of their
activity, but we are conscious of ours. No matter how complex
our acts are, and no matter how much intellectual reasoning ac-
companies them, their nature always remains reflex in spite of
their being termed voluntary. It is not our will that prompts
our reactions, but simply our desires or persistence of sentiment
that require satisfaction — hence our reaction. In legal medi-
cine, criminal acts committed with premeditation are considered
as being far more serious in nature than are acts committed by
impulse. This is due to our illusion of the conceptions of will
and consciousness. Neither the will nor consciousness cause any
reactions. It is the desire or persistent sentiment that call forth
the reaction, both in impulsive acts and in those with premedita-
tion. Will does not exist in either case, as it is superfluous.

Psychologists and moralists speak of inhibition as a voluntary
function. Formerly we believed in the existence of cerebral in-
hibitory centres. This was found erroneous and was supplanted
by simple antagonistic action. As the author does not admit the
existence of voluntary motor centres, however, he also discards

EDITORIAL. 3I

the notion of centres for antagonistic action. In order to in-
hibit an act, he says, the impulse that calls out the act should be
abolished or subdued, because the impulse expresses the desire
and sentiment. The inhibitory or antagonistic force, however,
cannot be voluntary, but it can be automatic. Individual educa-
tion of sentiments and passions regulates their intensity, form of
manifestation and automatic reaction.

Prof. Sergi insists that psychologists are nursing an illusion
when they deal with consciousness and will-power as psychologi-
cal entities.

THE HISTOLOGICAL BASIS OF REMISSIONS IN GENERAL

PARALYSIS.

The question of the periods of remission in general paralysis
is both interesting and puzzling. As the anatomopathology of
the disease consists of progressive and fatal destruction of the
cerebral elements, it is difficult to explain the occurrence of
periods of remission that are often characterized by marked men-
tal lucidity. Recent researches in cerebral histology seem to
throw some light on the subject. Dr. J. Dagonet, in Bulletin de
la Societe de Biologie (Oct. 22, 1904), considers the matter on
the basis of cerebral anatomy. He examined the brains of three
typical cases of general paralysis, using the Ramon y Cajal
newest method for coloring the neuro-fibrils. He found that the
latter remained intact, retaining their normal characteristics,
while the corresponding nervous cells were markedly altered.
This fact, the author says, indicates that the nervous cells are
not the trophic centres of the neuro-fibrils; the latter are in-
dependent of the cells. According to Dr. Dagonet, the persist-
ence of the neuro-fibrils explains the occurrence of remissions in
the general paralytic: even after attacks of hebetude of months'
standing, patients regain their normal consciousness.

It is most desirable that further studies of this question be
made and some more light be shed on the relation between men-
tal function, the nervous cells and their neuro-fibrils.

TRANSLATIONS AND ABSTRACTS OF CURRENT

LITERATURE.

Psychic Disturbances During the Course of Cerebral
Arterio-Sclerosis. — Drs. S. Soukhanoff and I. Vedenski: —

1. There are psychoses that are caused by and intimately re-
lated to cerebral arterio-sclerosis ; these psychoses are distinctly
different from senile dementia in the strict sense of this term.

2. A special form of mental feebleness of progressive course
characterizes the psychoses due to cerebral arterio-sclerosis.

3. The course of the disease is of long duration, bad progno-
sis, and may appear in various forms.

4. The main psychosis during the course of cerebral arterio-
sclerosis is dementia art erio -sclerotic a simplex. In some cases
may be observed acute psychic disturbances that are followed
by mental impairment. This mental impairment is characteristic
of itself. The psychosis due to arterio-sclerosis may assume
various forms, — melancholia, mania, amentia, etc., according to
the individual reaction {Journal Nevropatologii i Psychiatrii
Imeni Korsakova, No. 5, 1904).

{From the American Journal of Insanity, Vol. LXL, No. 2.)
1. A Case of Moral Insanity with Repeated Homicides
and Incendiarism and Late Development of Delusions

Dr. Henry R. Stedman : The history of the professional nurse,
J. T., who was held on the charge of murdering Mrs.. M. G., at
Cataumet, Aug. 13, 1901, is given in detail. It is stated that the
nurse had confessed having poisoned twelve patients and having
made two unsuccessful attempts to poison others. She said, in
part, "why don't I feel sorry and grieve over it? I cannot sense
it at all. I seem to have a sort of paralysis of thought and
reason." Among other impulses, she suffered from inclinations
to incendiarism. The conclusions in the medico-legal report of
this case are:

"1. The prisoner, J. T., comes of a family in which intemper-
ance and mental weakness and disorder are prominent disease,
features.

"2. Her utter lack of moral sense has been evident from child-
hood in her incorrigible proclivity to falsehood, dishonesty, mis-
chief-making, general unreliability and probable theft. The good
moral, mental and religious training which she received in her
youth resulted in no modification of her character, and were prac-
tically thrown away on her in that respect.

METABOLISM STUDIES, MENTAL DISORDERS. 33

"3. Her moral insensibility is further apparent in the absence
of sense of fear before, during or after the commission of her
crimes, and of course, sorrow or genuine affection at any time.
This defect is even more forcibly shown by the fact that her
chief victims were her especial friends.

"4. Her lack of any appreciation of her situation, her levity
under such circumstances, and her inability to realize the enor-
mity of her deeds are strong evidences of mental weakness.

"5. That an irresistible propensity propelled her to crimes
of arson and murder, is shown by the great frequency and variety
of such acts, and her continuance in them, regardless of conse-
quences.

"6. There is an absence of any apparent motive for her
criminal acts in some cases, and inadequacy of motive in many
of the others. This is shown in the total lack of evidence of
pecuniary gain or satisfaction in revenge as a rule, except minor
thefts and transient enmity. These would be powerless with sane
criminals as incentives to habitual homicide.

"7. The prisoner's disease-history and present mental state
correspond with a well recognized form of mental defect of a
moral type due to congenital degeneration, in which there may
be little or no intellectual disturbance that is apparent to the
ordinary observer.

"Therefore, we are of the opinion that she was insane and
irresponsible at the time of the homicides with which she is
charged, and is so now ; that, her disease being constitutional, she
will never recover, and that if ever at large again she would be
a constant menace to the community."

The patient eventually developed delusions of persecution.

2. Some iletabolism Studies with Special Reference to
ilental Disorders. — Otto Folin : The author claims that the
metabolism experiments, of which his conclusions are given be-
low, are the most extensive on record in connection with the in-
sane. He says :

1. From a constructive, positive point of view it must be
admitted that the experiments teach very little that is tangible
concerning mental diseases except for the strong suggestion that
they contain, — namely, that in general paralysis we have a disease
that may be associated at one stage or another with some demon-
strable metabolism disorders.

From among the other classes of the insane, individual pecu-
liarities or abnormalities of metabolism, i. e., pronounced varia-
tions from the standard values given in one of the tables in the

SENSATION AND MOTION.

paper, are also very numerous, but so far it has been found impos-
sible to identify any one metabolism peculiarity with any particu-
lar form of mental disorder.

2. From a destructive, negative or critical point of view, it is
believed that the data given prove the untrustworthiness of all
those metabolism experiments, old and new, which report a "char-
acteristic" increase or diminution of any of the urinary constitu-
ents included in this research (i. e., volume of urine, total nitro-
gen, urea, ammonia, uric acid, kreatinin, organic bases, total
sulphates, ethereal sulphates, "mitral sulphur," phosphates, chlo-
rides, organic or mineral acids, indican) as associated with any
particular one of the ordinary mental disorders.

It is not claimed that such characteristic abnormal metabolism
may not exist, but simply that the experiments recorded in medi-
cal literature are insufficient to demonstrate the fact.

3. From a general physiological point of view, it is believed
that the data contained in a table in the paper are valuable as
regards the exact figures of composition of a large number of
urines, tending to throw light on the laws of the normal composi-
tion of urine.

3. Sensation and Motion.— Dr. Frederick C. Gessner:
Special remarks are made on sensation and motion. Some of the
conclusions are that motion reveals itself merely as the means by
which nature expresses and communicates sensation; sensation is
the soul of all existence, motion is the image ; and if motion pre-
vails throughout the universe, it only proves that sensation is
omnipresent.

{From "Mental Defectives" Barr).

1. Idiots Savants. — Some of the remarkable cases of "learned
idiots" are cited here. Langdon Down: — One boy could
model ships from drawings and carve with great skill, yet
could not read a sentence. Another exhibited marvelous skill with
crayons, while his higher faculties of the mind were a compara-
tive blank. Another case is that of a boy with tenacity of
memory : having once read a book, he could recite pages verbatim
without an error. Another boy could tell the tune, words and
number of almost every hymn that he had read. Another boy
could tell the name and address of every confectioner's shop he
had ever visited, and the date of each visit. One child could tell
the date of arrival of all the children at the institution, and could

ASEXUALIZATION. 35

give accurate information of each when needed. One boy, about
twelve years old, could multiply any three figures by three other
figures with perfect accuracy, as rapidly as they were written;
yet he was of such low mental grade that he could not tell the
name of his physician whom he saw daily during a period of two
years.

Maudsley describes the case of an imbecile who, after once
reading a newspaper, could, with his eyes shut, repeat what he
had read word for word.

In the Asylum of Earlswood, England, the author saw a case
of a middle-aged man, an imbecile of middle-grade, who was a
wonderful engraver, and could copy steel engravings with such
accuracy and precision that it was almost impossible to distinguish
the copy from the original.

"Blind Tom," a wonderful musical idiot savant, was able to
catch and reproduce any air he heard, and to play two tunes on
the piano at the same time. Of very low grade, he would get up
when his playing was finished and applaud himself.

The peculiar gifts of the idiot savant include aptitudes for music
and art, powers of imitation, rapidity in arithmetical calculations
and a retentive faculty especially as regards dates and events.

The author agrees with Down that the idiot-savants are almost
exclusively male subjects. The only female idiot-savant of which
the author has read is Quenan, an idiot at the Saltpetrier, who was
a rare musician.

2. Asexualization. — Dr. Everett Flood reports 26 cases in
which the operation was practiced ; 24 of the cases were epileptics.
Some years after the operation, the mental condition was improved
in only three cases, the moral — in four, two kleptomaniacs had
reformed, one who was salacious had improved, and the temper
was improved in all but four cases. The sexual appetite seemed
to disappear in all but two cases, and appeared in these only peri-
odically. The effect on the epileptics was favorable. In some
cases the attacks ceased altogether, while in others they returned
after an immunity of two years.

Sexual desire is not abated if the operation is performed late in
life.

3. The Love oi Music, that seems the one clue leading
through the maze of the development of backward races and of
degenerate natures, is strongly evidenced among the feeble-
minded. Susceptible both to its influence and training, they
readily absorb the mysteries of notation, harmony and rhythm.

36 THE CAUSES OF IDIOCY.

Although the majority of the defectives susceptible to instru-
mental music are chiefly of high grade, some of middle-grade
frequently also show an eagerness and perseverance in the study
of music ; this is generally a marked contrast to their apathy and
indifference to letters and figures.

The Causes of Idiocy. — Prof. Kovalevski: A long list of
causes of idiocy is given, among which are heredity, alcoholism,
syphilis, scrofula, tuberculosis, chronic inanition, etc. Epilepsy,
the neuroses and psychoses are also considered. The largest num-
ber of idiots come from idiot parents. Although marriages be-
tween iodiots are rare,Esquirol published a case of an idiot mother
who gave birth to two idiot children and Howe reported a case of
idiot parents who gave birth to three idiot children. Psychopa-
thic parentage gives a percentage of 45 to 50 idiot offspring. If
the mother suffers from neuro- or psychopathic disturbances, the
first born children are generally affected with idiocy, and if the
father is subject to psycho- or neuro-pathias, the last children are
born idiots. Consanguineous marriage is an important source of
idiocy, epilepsy, deaf and dumb subjects, etc. Seventeen families
of consanguineous marriage gave the following results : of their
95 children 44 were idiots, twelve scrofulous and undersized, and
deaf and dumb and one a dwarf. According to various statistics,
idiocy ranges in such familes between 5 per cent, and 3.76 per
cent. The evil, however, lies not in the consanguinity, but in the
physical and mental status of the parents. Alcoholism of the
parents is responsible for 41. 1 per cent, of idiot children. In such
cases the alcoholism is not necessarily of long duration; intoxi-
cation at the time of sexual congress suffices to cause the evil.
This fact is confirmed by statistics and by verbal statements of
mothers whose children are idiots. Although the percentage of
idiots brought into the world by active syphilitic parents is small,
the noxious effect of this disease cannot be denied : the majority of
children born of syphilitic parents die during infancy or do not
survive uterine life. Bourneville gives the percentage of idiocy
from this cause as 1 per cent., Piper and Timofeiev, 5 per cent.,
the author himself found among 70 idiot children, 6 whose parents
were syphilitic, or 8.5 per cent. The children of syphilitic parents
are more apt to be afflicted with juvenile dementia and insanity.
Alcoholism of the wet-nurse, forceps delivery and other causes are
also enumerated (Vestnik Dushevnikh Boleznei, No. 6, 1904).

The Psychic Slowing and Disturbances of Evocation of Ideas
of the Melancholiac. — Masselon : The process of evoking ideas

INJURY TO THE CERVICAL PORTION OF THE SPINAL CORD. 37

is a complex phenomenon into which various cerebral factors
enter. The evocation may be spontaneous — accomplished without
any mental effort, or voluntary — through mental effort. The
process involves direction of the mind, and attention by virtue of
which the direction, images, ideas and mental representations are
fixed in the mind. It is endeavored in this study to find which of
these mental factors is most impaired in the melancholiac. The
cases of melancholia chosen are those of true melancholia — par-
ticularly designated by Kraepelin as melancholia of presenile in-
volution. The tendency of mental direction seems to be intact in
the melancholiac : when asked a question he knows in which direc-
tion the ideas of his answer should be made ; he tries to fix his at-
tention in order to have a clear mental representation of his answer
and attempts by a mental effort to strengthen the representation.
His attention, however, is fixed slowly and with great difficulty.
Besides, even when he succeeds in fixing his attention there is
slowness and difficulty in the evocation of ideas. The patient
realizes, nevertheless, the failure of his attempt and this conscious-
ness makes him suffer. This feeling contributes to his mental pain.
Melancholia is characterized primarily by disturbances of evoca-
tion of ideas and slowing of the psychic process. The different
factors of the evocation of ideas, however, are differently im-
paired. The tendency of mental direction remains intact : even
the stuporous melancholiac knows how his answer should be di-
rected and he makes efforts to direct it properly. The disturb-
ance is more marked in the domain of attention, the latter being
fixed with difficulty. The main disturbance lies in the represen-
tation of ideas that are evoked with great difficulty. The con-
tents of the representation is intact, but its evocation is slow an^1
difficult. This psychic slowing of the melancholiac is due to dis-
turbances of mental synthesis : an impaired vivacity of the mental
images is the cause of the difficulty of evocation. The mind's
logic remains intact, but the elements of the mind are less capable
of movement and direction (Journal de Psychologic Normale et
Pathologique, November-December, 1904).

A Case of Injury to the Cervical Portion of the Spin-
al Cord with Post mortem Examination Dr. J. How-
ard Morgan : A man fell from the second to the first floor of
a building and sustained a fracture of the spinal column in the
cervical region. After the accident the patient's pulse became in-
termittent and there was paralysis of the voluntary muscles below
the neck, anesthesia below the upper deltoid region in the arms,

38 EPILEPSY, PATHOGENESIS, ETC.

and in the rest of the body below the third or fourth ribs. The
rectum and bladder were paralyzed, the pulse was subsequently
irregular, oscillating between 54 and 60 beats per minute and the
temperature was 97.2 to 98 degrees F. The reflexes were
markedly exaggerated and more marked in the left leg than in
the right. Eight days after the accident the diaphragm presented
complete paralysis and it was impossible for the patient to breathe
with the right chest, the left side of the chest alone showing ex-
aggerated breathing. The patient died three days later. The
autopsy showed that the laminae of the fourth and fifth cervical
vertebrae were fractured, there was an extra-medullary hemor-
rhage, but no external wound of the cord. Near the upper portion
of the cervical enlargement of the cord, on the right side posteri-
orly, was a faintly bluish discoloration nearly 1.5 cm. in length/the
situation corresponding very nearly with the fourth, or fourth and
fifth cervical vetebrae. Microscopic sections showed the vessels to
be fuller of blood than usual about 2 cm. above the discoloration ;
1 cm. above the discoloration the small beginnings of fusiform
clots were shown in cross-sections; the section through the dis-
colored portion presented more blood and reddish softening of
the right posterior and lateral columns. Below this region the
hemorrhage extended downwards, involving the central portion of
the cord and finally passing into the left anterior column at a
point near the lower portion of the cervical enlargement — at about
the upper portion of the second dorsal vertebra. Below this point
the cord was apparently normal throughout (The Providence
Medical Journal, November, 1904).

Epilepsy, Pathogenesis and Therapeutic Indications.
Second Part: Treatment of Epilepsy. — Dr. Alexander

Paris : The first part of this paper was reported in Vol. VI, Nos.
1-2, 1904, page 35, of this Journal. In the second part the treat-
ment of epilepsy is considered on the basis of the pathogenesis of
the disease. No new ideas are presented: the bromides, hygiene,
diet, calm:, etc. are recommended. Prophylaxis of the disease is
insisted upon and especial stress is laid on the prophylactic treat-
ment of the fetus of epileptic parents. Moderation of the func-
tional activity of the thyroid and genital glands should be ob-
served. Moderation of the thyroid gland can be regulated by
causing moderation of the genital organs. This can be accom-
plished by increased activity of another glandular system — the
liver, kidneys, skin. Camphor, lupulin, prolonged baths, diuretics
and laxatives will bring about the desired results. The main
point to be attained in the curative treatment is to moderate the

LUMBAR PUNCTURES. 39

brain excitability common to the elipeptic. The bromides generally
bring* about the desired results. When the bromides fail, the ad-
dition of trional, from' i toi^ grams is highly recommended. As
the epileptic is often of rheumatic diathesis, the author has tried,
and with success, benzoate of lithine. The lithine acts on the
kidneys and the benzoic element probably decreases the thyroid
activity. Lavage of the blood, laxatives, etc., should also be con-
sidered. Camphor administered from time to time serves a double
purpose : depressing the genital activity and acting as an intestinal
antiseptic. If good results are obtained in some cases from in-
jections of artificial serum, the method is not always tolerated by
the patient and not easy of handling in private practice. If the
proper treatment were instituted for epileptics in due time — before
they are born, the disease could readily be eradicated (Arch, de
neurologie, November, 1904).

Lumbar Puncture from the Diagnostic and Thera-
peutic Points of View. — Gerhardt: Lumbar puncture is
of varied clinical utility. Among others, it helps differentiate
between various cerebral complications of acute diseases and
cerebral abscesses that can be remedied by surgical intervention ;
it helps differentiate between cerebral syphilis and other diseases
of the brain and spinal cord (excepting tabes) and between gen-
eral paralysis and the simple psychoses. Therapeutically lumbar
puncture is used in cases of acute and sub-acute serous meningitis
and in syphilitic cephalalgia. The results are less favorable in
hydrocephalus, meningites and cerebral tumors. Although' 26
cases of death consequent on lumbar puncture have been published,
the operation is not accompanied by any danger. The precautions
to be taken are : regulation of the flow of the fluid, extraction of
a few cc. only and the avoidance of lumbar puncture in cerebral
tumors. Nonne has seen recovery from traumatic hydrocephalus
after repeated punctures. He also cautions against puncture in
cases of cerebral tumors. Schoenborn has practiced puncture on
100 patients in the Heidelberg Clinic : 25 patients with tabes pre-
sented lymphocytosis without exception; the same was true of 13
cases of meningitis; three out of five cases of multiple sclerosis
presented lymphocytosis; negative results were obtained in cases
of tetanus, vertebral caries, cerebral tumors and neuroses. Cryo-
scopy of the fluid was practiced in 20 cases and the results were
not constant. Tobler has made 120 punctures on children. Young
children stand the operation particularly well. In one of his cases
of epidemic meningitis 100 cc. of the fluid was drawn and 650 cc.
was drawn in a case of hydrocephalus. Where there is no aug-

TREATMENT OF EPILEPSY.

mentation of the fluid, he says, one should be careful, as the ex-
traction of even a small quantity of the fluid is followed by some
meningeal symptoms. Therapeutically, good results have been
obtained in cases of cerebral compression and post-meningeal
idiocy (Archives de neurologie, November, 1904).

Treatment of Epilepsy. Hyperbromuration Through Hy-
pochloruration.. — Dr. Ch. Achard: The hypochlorurated diet
does not, in itself, cause a decrease in the number of epileptic at-
tacks ; nor does hyperchloruration cause an increase of their num-
ber. The variation of the amount of chloride in the organism
is the effect, not the cause, of epileptic attacks. Salt diminishes
the action of the bromides. Not all salts have a similar effect.
Phosphate of sodium, for instance, may be given to epileptics in
doses of from 5 to 10 grammes without influencing the action
of the bromides administered at the same time. Chloride of
sodium seems to influence the effect of salts quite near to itself
in nature, — the halogenous compounds : the bromides and, per-
haps also, the iodides. A milk diet is an excellent hypochloru-
rated diet. Unfortunately, patients tire of the monotony of this
diet. A mixed diet free from salt is preferable. According to
Toulouse, the diet need not be achlorurated ; it is sufficient that
it be simply hypochlorurated. The amount of salt we daily ab-
sorb with our food is 2 grammes. This amount is abstracted in
the treatment of epilepsy by hypochloruration. The amount of
bromide given during this regime is from 2 to 4 grammes. When
the patients seem improved, it is well to increase the daily al-
lowance of salt before the dose of bromide is decreased. This
modification should be made very gradually, in the course of
months, and even years.

When bromides are administered during hypochloruration, it
is important to closely watch the patient's condition : severe toxic
effects are apt to be manifested in some cases, even when small
doses of bromide are being administered. Merklen and Heitz
report such cases. Salt in the economy has a protective in-
fluence against poisons. Hypochloruration, consequently, de-
creases this protective influence {Role du sel en therapeutique,
1904).

Saturnine Intoxication.— Dr. Ch. Mirallie: Lead poison-
ing affects all the tissues of body, but the nervous system is
especially predisposed to saturnine intoxication. Lead poisoning

PROGRESS IN THE INDIAN SCHOOLS. 41

among the working classes is aggravated by the fact that al-
coholic abuses generally accompany it. In France, there is a
popular belief that absinthe is an antidote for lead poisoning.
The results of this combined poisoning among the working classes
can readily be imagined.

The descendants of parents affected with lead poisoning are
also profoundly affected. Abortions are frequent among preg-
nant women affected with lead poisoning. Balland reports ioo
cases of pregnancies during the course of lead poisoning. Of
these, 42 ended in abortion, 32 in premature birth, and 6% were
still-born. The children who are brought into the world are
sickly. When the lead poisoning affects the father, the results
are quite as bad. The author quotes the 300 pregnancies in 59
families reported by Bourneville, showing the effect of paternal
lead poisoning: 112 pregnancies ended in abortions and still-
births, some of the infants died of nervous disturbances, 2"/
children died from other causes than lead poisoning, 62 children
were abnormal, idiots, epileptics, etc., and only 99 children were
normal. Porak's case is cited, in which all the organs of a fetus,
conceived while one of the parents was suffering from lead poi-
soning, contained lead. The encephalopathias due to lead poison-
ing are grave in nature, and a patient thus affected may die with-
in a few days from the onset of the disturbance. Various mental
disorders may characterize the affection.

The struggle against lead poisoning among the workers en-
gaged in the lead industries in France has been going on for the
iast 125 years. At various times the medical profession has
pleaded for the substitution of non-toxic substances for the most
toxic lead compounds, — white and red lead. The Senate is con-
sidering the question regarding the industrial uses of white lead.
Hope is entertained that in the near future the law will enforce
the substitution of harmless substances for white lead now gen-
erally used in various industries {Gazette Medicate de Nantes,
No. 50, 1904).

Progress in the Indian Schools.— The Annual Report
1904, of the Superintendent of Indian Schools, Miss Estelle
Reel, has been submitted to the Commissioner of Indian Affairs.
It is shown that educational advancements have been made dur-
ing the year in the general field of Indian education. The
Indian child is taught to speak English in a shorter time than
formerly. The policy of giving agriculture foremost place in
Indian education has been continued during the year and the re-

42 A CASE OF BRONZED DIABETES.

suits obtained are satisfactory. The report states that marked
improvements have been made in the method of instructing the
boys in the various trades and the girls in cooking, sewing, laun-
dry work and general housekeeping The day schools have con-
tinued their good work, and their civilizing and elevating in-
fluence on the older Indians becomes more apparent every year.
Statistics are given in which it is shown that the products of
native industries have a greater value to the Indian than is gen-
erally known and that they form a substantial aid toward his
support.

Among the evidences of the good results of Indian education
are the reports of the career of returned students, which show
that they are endeavoring to overcome the environment of camp
life and prove themselves worthy of the education they have re-
ceived. A feature of the report is the evidence it gives that the
Indian is altering his ways of living to meet the requirements of
an advancing civilization through the educational influence of
the schools on the children who are being taught the white man's
ways of living.

A Case of Bronzed Diabetes with Consideration on
the Evolution of the Disease. — Dr. Margain: The
patient was 47 years of age. There was no rheumatic or ma-
larial history. Chronic alcoholism in the past. Polyphagia of a
moderate degree, polydipsia, polyuria and pollakiuria were of
two months' standing. Bodily wasting and spells of ascites had
set in two years previously. The patient's skin was uniformly
pigmented, the coloring being of a deep hue. The mucous mem-
branes were normal in color. Retraction of the palmar aponeu-
roses of old standing. The conjunctiva and under-surface of
the tongue were jaundiced. Marked adynamia. Marked tender-
ness in the hepatic region. Liver, hard and voluminous. Di-
gestion and respiration, normal. Pulse, irregular. Blood ves-
sels, hard to touch. Absence of patellar reflexes. Other re-
flexes normal. History of old neuralgias, and painful feelings
in the seats of the old neuralgias. Depressed mental condition.
Death — after a spell of bronchitis and generalized edema.

At the autopsy: the liver weighed 1,930 kgr. and was of a
rusty color ; spleen, dark, weighed 265 grammes ; heart, markedly
hypertrophied, weight, 600 grammes; brain, kidneys and supra-
renal capsules normal; lungs, not tubercular. Histologically,- —
bi-venous cirrhosis, formation of pseudo-biliary ducts. Sclerosis

DEVELOPMENT OF HYSTERIA IN CHILDREN. 43

of spleen, pancreas and heart. Pigmentation and hypertrophy
of connective tissue of lungs.

The symmetrical retraction of the palmar aponeuroses ap-
parently indicates a disturbance of the trophic centres or of the
peripheral nerves. It is questionable whether this aponeurosis
retraction is an essential feature of "bronzed" diabetes. The
latter disease, however, is probably intimately connected with
some nervous disturbance: sometimes ocular disturbances ac-
company it, and there is always abolition of the patellar reflexes.
This abolition may be tardy in onset (Progres Medical, No. 40,
.1904).

Development of Hysteria in Children. — L. Babonneix :
Hysteria in children is generally due to heredity. As a rule, the
disease is inherited from the mother. Among 80 hysterical
children, Briquet found 58 cases of parental hysteria, 2 cases of
insanity and 3 of epilepsy of the parents. Of the author's own
16 cases, there were 7 histories of parental hysteria, besides 11
histories of neuroses and 3 of psychoses in the respective fami-
lies. Among the various hereditary predispositions are men-
tioned neuropathias, rheumatic and gouty diatheses, malnutri-
tion, tuberculosis, etc. Hysteria rarely occurs in children under
six years of age.

Physiologically, the young hysterical subjects suffer from
faulty nutrition and intoxication therefrom: indoxyl arid, some-
times, oxalate of lime are increased in amount in the urine. Con-
stipation is habitual.

Psychologically, hysterical subjects are given to lying. In
children, the hysterical stigmata are not always found; anesthe-
sias are rare, abolition of the pharyngeal reflex is not always
found, and conjunctival hypoesthesia is insignificant. The most
characteristic trait of hysterical children is their suggestibility
and lack of inhibitory psychic function. Suggestion alone suf-
fices to cause hysterical attacks in these subjects. Heredity may
be absent in some cases, but a certain predisposition always un-
derlies the trouble. The prognosis is not bad in children, — if
proper treatment is instituted in time (Gazette des Hopitaux,
Dec. 15, 1904).

All Crazy Within 700 Years. — According to American
Medicine, Vol. VIII, No. 13, 1904, a Chicago scientist has as-
serted that all human beings will have gone insane within 700

ANTI-RABIES VACCINATION IN ST. PETERSBURG.

years. Among the causes of the increase of insanity he men-
tions are : drink, over-indulgence in drugs, the mad rush for
money, physical and mental over-exertion; the high nervous ten-
sion of life, and the present condition of woman as wage-earner
and mother. The society woman also contributes to social de-
cay: her strenuous life is also detrimental to society. The gay
life of pleasure of the society woman, and the drudgery of the
wage-earner "are continuously decreasing their nervous strength
and energy, and brain-fagged and physically exhausted they
marry; they become the mothers of physical starvelings, ,who
develop into men and women unfit for the burdens of life. These,
in their turn, live in the manner of their parents, weaker, and
even less able to stand the nervous tension of work and dissipa-
tion. These people are often predisposed to insanity and ner-
vous diseases, while often the result is degeneration and im-
becility. When men make it possible for women to return to
their proper place of home and motherhood, and they can cease
the pitiful struggle for existence, leaving the obtaining of a
livelihood to the men of the family, then the conditions that pro-
duce insanity will diminish. Among the foreign laborers, bad
whiskey and beer cause more insanity than does anything else.
The reason is that drink is adulterated with cocculus indicus, or
'fishberry,' that is used by the Chinese in catching fish. In
other words, drugs and whiskey combined are good combinations
upon which to build a lunatic."

Anti-rabies Vaccination in St. Petersburg. Annual Re-
port of the Imperial Institute of Experimental Medicine.

— Dr. V. Kraiouchkine : 1165 persons bitten by mad dogs and
other animals presented themselves for treatment, in 1902. For
various reasons, only 819 of that number had been treated with
the Pasteur method. The gross mortality was 0.9%, but specific
conditions warrant the conclusion that the mortality was only
0.4%.

The number of animals brought for treatment was 699. Of
this number, 246 dogs and 7 cats were affected.

Fifty-eight brains of animals had been received for examina-
tion from various provincial places ; the virus was found in 36
of the specimens. For diagnostic purposes, 354 autopsies and
153 inoculations had been practiced.

The relatively small number of affected animals among those
examined is explained by the fact that the St. Petersburg police
send to the Institute all animals that have bitten anybody.

STUDY OF BINUCLEAR CELLS.

New Data Relating to the Study of Binuclear Cells.
Experiments Hade on Guinea-Pigs by Poisoning with
Phosphorus and Bacilli of Yellow Fever (Sanarelli). —

K. A. Koutchouk: Certain pathogenic agents affect the rela-
tive quantitative number of mononuclear and binuclear liver
cells of the guinea-pig. The respective proportion of these cells
is changed according to the agent used for the purpose. Poison-
ing with phosphorus was followed by a relative augmentation of
the binuclear cells, while infection with the bacillus of typhoid
fever was followed by opposite results. In a previous paper it
was demonstrated that ligation of the common biliary duct was
followed by a relative decrease of the number of binuclear cells.
The decrease was from 9.88% to 5.86%. Ligation of the biliary
duct gave results similar to those obtained from infection due to
bac. icteroides Saranelli. The general microscopic changes were
also similar in these cases.

These experiments show that the principal integral parts of
the cell have their biological autonomy, — the parts being the
nucleus and the cellular body. In the experiments it is seen
that the nuclei may multiply, while the corresponding number of
cells remains unchanged (Archiv Biologicheskikh Naouk, Vol.
X, No. 4, 1904).

Some Forms of Dwarfism and Their Treatment with
Thyroid Glands. — Bourneville: Infantile myxedema espe-
cially responds to thyroid treatment. Nutrition becomes
markedly ameliorated, and all the functions of the body show an
improvement. Intelligence is awakened, the muscular and
osseous systems develop, the fatty infiltration disappears, the
skin and the sweat-glands become normal. Respiration and cir-
culation become regular, the puffiness of the face, hands and feet
disappears. The growth of hair improves, and in female sub-
jects menstruation appears. The earlier the treatment is com-
menced, the more beneficial it is for the subject. Improvement
in subjects under treatment since childhood is so marked that
an inexperienced observer would have difficulty in recognizing
them as sufferers from myxedema.

The characteristic feature of Mongolian idiocy is arrest of
growth. Under thyroid treatment the growth is stimulated.
When the bodily growth appears to progress satisfactorily, it is
advisable to suspend the treatment and watch the case. Should
there be any indication that the growth is not progressing, the

46 HEMI-HYPERTROPHY, INTERNAL ORGANS INVOLVED.

treatment should be resumed. In some cases thyroid treatment
during a given period is sufficient to start bodily growth that
continues of itself after the treatment is suspended (Progres
Medical, No. 50, 1904).

A Case of Hemi-Hypertrophy in which the Internal
Organs Were Also Involved. — Dr. Robert Hutchinson:
*A child, four months old, the fourth child in the family; all the
other children are normal, the parents are healthy. The preg-
nancy had been normal and birth took place under normal con-
ditions. The child was well formed at birth, except for a capil-
lary nevus on the right knee, lower part of the left arm-pit and
under the left scapula. The asymmetry developed gradually.
When examined, the child presented hypertrophy of part of the
left side of the body, the left arm and leg. The head, face and
tongue on the left side were normal. The hypertrophy seemed
to be due to subcutaneous infiltration of tissue. The child died
of broncho-pneumonia in the left chest. At the autopsy it was
found that the hypertrophy was due to fatty infiltration. There
was no trace of vascular dilation in the hypertrophied tissues.
The bones were of equal dimensions on both sides. The brain
was normal and symmetrical. The pituitary body was normal.
The difference in weight of the respective organs : left kidney,
56 grammes; right, — 28; left supra-renal capsule, 42 grammes,
right, — 14; left testicle, 2 grammes, right, — 0.55. The differ^
ence of weight between the lungs could not be determined. The
heart was normal, and the two lobes of the thyroid gland were
normal {Annates de Medicine et Chirurgie Infantiles, No. 24,
1904).

Infantile Cerebral Hemiplegia and Hemiataxia. — Dr.

Bouchard : The child is four years of age, left-handed. It was
noticed at the school he was attending that he had become ir-
ritable and taciturn. Medical aid was sought on account of the
psychic change. An examination revealed the presence of right
hemiplegia of the entire half of the body. There was also hemi-
ataxia of the right limbs when voluntary movements were at-
tempted. According to the history, the child had hemiparesis at
birth. The troubled had gradually developed. A cerebral lesion
originating during intra-uterine life was undoubtedly the cause
of the trouble; the latter was aggravated during delivery that
was difficult. The point of interest is the ataxia particularly

TROPHIC DISTURBANCES, TABES DORSALIS. 47

marked in the right upper limb. Ordinary infantile hemiplegia
is generally not accompanied by ataxia. It is also noteworthy
that in this case there were no spasmodic phenomena, atrophy,
deformity or exaggerated movements. The ataxia takes place
only when voluntary movements are attempted. The motor dis-
turbances are analogous to those found in sclerose en plaques,
but differ from them in many respects.

The hemi-ataxic form of infantile paralysis is not mentioned
in classic works, — probably because it is of rare occurrence. The
author has had occasion, however, to observe cases of infantile
hemiplegia accompanied by hemi-ataxia in addition to the
spasmodic phenomena and hemi-athetosis {Journal des Sciences
Medical de Lille, No. 50, 1904).

The Question of Trophic Disturbances During the
Course of Tabes Dorsalis. — Dr. V. Dobrokhotov publishes
a case of tabes dorsalis with unusual trophic disturbances and
fever manifestations. Antiseptic treatment of the mal perforant
and administration of arsenic did not influence the wounds dur-
ing a period of a month. X-rays were then applied. According
to the author, improvement was noticeable after the first sitting.
After the second sitting, the edema of the tissues had disap-
peared; progressive and final healing of the wounds took place
within some three weeks, — during which the X-rays had been
applied at given intervals.

The temperature rose as high as 40 degrees C. at times. This
was not due to infection, — because there were also spells of fever
after the wounds had healed.

Trophic disturbances are met with mostly in cases with
marked sensory disturbances. Theories regarding this com-
bination are analyzed. Mal perforant is often an early forerun-
ner of tabes dorsalis, often setting in long before the ataxic symp-
toms become apparent. According to Brissaud, an intimate re-
lation exists between the shooting pains and the trophic dis-
turbances. Mercurial treatment of the latter may prove bene-
ficial, without affecting the course of the locomotor ataxia. Ball
and Thirbierge's 3 cases are cited to this effect. The author's
own case leads him to ascribe the cure to the use of the X-rays
(Journal Nevropatologii i Psychiatrii Imeni Korsakova, No. 5,
1905).

48 ACUTE PSYCHOSES STUDIED HISTOLOGICALLY.

Considerations Regarding Five Cases of Acute Psycho-
ses Studied Histologicaly. — Dr. A. Deboubais: Histologi-
cal studies of the brains of five cases of different psychoses are
presented. General conclusions: histologically, there are two
well denned groups of acute psychoses, — paralytic or interstitial,
and non-paralytic or parenchymatous. It is probable that
eventually chronic psychoses will also come under the heading
of the parenchymatous group. Under such conditions, an
anatomopathological basis of study of psychoses can become
practical.

It is also probable that a pathogenic unity underlies all the
clinical varieties of acute psychoses, — in the sense of cerebral
resistance: the course and termination of an acute psychosis de-
pends on the intensity of action of the pathogenic agent, and
especially on the cerebral resistance. Otherwise, there is no his-
tological difference between the acute and chronic psychoses
{Journal de Neurologie, December 5, 1904).

The Toxin of Fatigue and Its Anti -Toxin. — Weich-

ardt has published a paper under this title in the Muench. Med.
Wochenschr., No. 48, p. 2121, 1904: Fatigue causes the forma-
tion of a special toxin in the muscles. It is difficult to obtain a
sufficient quantity of this toxin in animals for examination, be-
cause during moderate fatigue an antitoxin that neuralizes the
toxin is also formed. The toxin can be obtained from the
muscles of animals fatigued experimentally, — so that death fol-
lows from the peculiar intoxication. The toxin obtained from
such animals and injected into normal animals causes death in
the latter. The author has also succeeded in obtaining an anti-
toxin in question. The anti-toxin is readily absorbed in the in-
testines. The author has experimented on himself with this sub-
stance and claims to have obtained satisfactory results (Gazette
des Hopitaux, Dec. 15, 1904).

The Endocellular Fibrillary Network and the Axis.
Cylinders of the Nervous Cells of the Vertebrate, Various
Methods of Elective Staining of the Endocellular and
Peripheral Network Based on the Action of Pyridin on
Nervous Tissues. — Dr. Arturo Donaggio : This is an ex-
exhaustive paper on the method of staining the finer nervous
elements. The minute anatomy of the endocellular networks of
the nervous cells is examined in detail. There are cells that have

EPILEPTIC ATTACKS AND URINARY ELIMINATION.

a single endocellular network; the latter is connected with the
fibrillary prolongations. Other cells have a double network, in
which the fibrils of one of the networks run through the cellular
elements. The author submits an interesting hypothesis on endo-
cellular nerve currents. He suggests the idea that cells with a
single endocellular network are destined for nerve currents in
one direction only, while those with a double network conduct
currents in two directions. The axis-cylinder connects with both
networks in cells that have two networks. The axis-cylinder, con-
sequently, conducts two kinds of currents when connected with
a double endocellular network. In other words, there are cellulo-
fugal and cellulo-petal currents.

Excellent plates illustrate the networks in question (Rivista
sperimentale di freniatria, Vol. XXX, fasc. 2, 1904).

Epileptic Convulsive Attacks and Urinary Elimination. —

J. and R. Voisin and Krantz : Epileptic convulsive attacks
do not directly modify the urinary elimination either as regards
the amount of chloride of sodium or the elements of disassimila-
tion. When there is a series of attacks, there is an augmented
elimination ; whereas before and after the attacks there is reten-
tion of the substances.

An epileptic attack is, therefore, a consequence of an intoxica-
tion by retention, but is not the cause of the intoxication and re-
tention. The latter can also be found in non-epileptic mental de-
fectives. The convulsive attack of the epileptic is in relation with
the quantity and quality of the retained products. The retention
may be due to a hereditary or acquired susceptibility of the
nervous cell (Progr.es Medical, No. 50, 1904).

fleas u ring Gustatory Sensibility in Man and Woman. —

Vaschide: Gustatory sensibility in appreciating salty taste is
finer in man than in woman. Bitter is also appreciated readier by
man, but the difference in degree of appreciation is less marked
than in the instance mentioned above. Gustatory appreciation
of acid and sweet is equal for both sexes. Woman's readiness
in recognizing odor-taste is superior to that of man. In her
household and toilet occupations, woman acquires this fineness
of appreciation (Progres Medical, No. 50, 1904).

Acidification of the Viscera. — A Sure Sign of Death. —

Brissemorel and Ambard: The viscera, liver and spleen are
alkaline during life; they rapidly become acid after death. This
acidity can be demonstrated by puncturing the liver or spleen

URINARY ELIMINATION DURING DECHLORURATION.

■*

with a capillary needle and depositing the pulp on blue litmus
paper. If death occurred shortly before the puncture is made,
tlje reaction is only slightly acid, but if of long duration, — a red
spot is seen on the under-surface of the litmus paper. These
^phenomena are constant and may be observed even fifteen min-
S utes 'after death (Progres Medical, No. 50, 1904).

.Urinary Elimination During the Course of Dechloru-

^uon. — J. and R. Voisin and Krantz have observed the
urinary elimination under the influence of dechloruration in men-
tal defectives and epileptics. The general amount of urinary
elimination is decreased, while there is an augmented elimina-
tion of the elements of disassimilation (urea and total nitrogen).
The amount of phosphates eliminated is decreased. If certain
authors, in experiments made on themselves, found an aug-
mented elimination of phosphates (Claude), the incident was
due to a psychic factor that is absent in the demented and epilep-
tics (Progres Medical, No. 50, 1904).

Preparation of a Neurotoxic Serum by the Method
of Rapid Immunization. — Armand Delilie has obtained a
neurotoxic serum for dogs. The serum is obtained by making
repeated intra-peritoneal injection into guinea-pigs, every five
days, during a certain length of time; the substance injected is
an emulsion of cerebral substance of a dog. The serum of a
guinea-pig that had reoeived one gramme of a dog's brain, five
times, is neurotoxic: an intra-cerebral injection of that serum,
one centigramme per animal kilogramme of a dog, kills the latter
within a few hours. 'Smaller doses cause convulsive attacks and
torpor (Progres Medical, No. 50, 1904).

New York City's Crime Record for Quarter Ending June

30, 1904. — Quoting from the Report of the Police Department,

the New York Times says that in the five boroughs, a total

of 46,643 arrests were made. Of that total, Manhattan and the

Bronx are responsible for 34,101. More than 4,000 arrests were

for various degrees of assault. Unmarried persons made up

29,314 of the grand total. Only 453 persons were unable to read

and write. The arrests cover all sorts and conditions of social life,

and almost every trade. There are no bankers in the list but

there are brokers and agents and dealers of all kinds, as well

as twenty-six editors and reporters.

COST OF PUBLIC SCHOOLS. 5I

Cost of the Public Schools for the Year Ending June 30,
1904. — According to reports of the daily press, the total cost
of the public school system, as given by the Commissioner of
Education, is $251,457,625. This is an increase of $16,000,000
over the previous year. In the public schools there are 16,009,361
pupils, or 20 per cent, o'f the entire population of the country.
As compared with the previous six years, this percentage shows
a slight decrease in the number of pupils as compared with the
total population. The enrollment in the private schools for the
year is given as 1,093,876.

War Death Roll of a Century. — According to an ex-
change, Prof. Riehet, of Paris, sums up the total of dead in
wars during the last century as 14,000,000. Of this total the
Napoleonic wars come in for 8,000,000; Crimean wars, 300,000';
Italian wars, 300,000; American Civil war, 500,000; Franco^
German war, 800,000; Russo-Turkish war, 100,00; Civil wars
in South America, 500,000; various colonial expeditions in India,
Mexico, Tonquin, South Africa, etc., 3,000,000.

The Armies of the Greatest Battles in Modern History. —

In the battle oi Liao-Yang there were 250,000 Japanese fighting
against as many Russians. An exchange says that in no other
battle recorded in history is it certain that so many men took
part as met on that Manchurian plain. At the battle at Leipzig,
between Napoleon and the allies, 430,000 men were engaged.
The battle of Waterloo was fought by 190,000 men. In the Civil
War, the three days' battle at Gettysburg was fought by 172,000
men. The enormous armies said to have been raised by the
ancients are considered as exaggerations.

An Address Delivered by a Deaf and Blind Girl. —

The Hall of Congress, at St. Louis, was filled to its capacity by an
eager audience when Helen Keller delivered her address there.

Objection to Execution in Prisons — In a report to the
Governor, some officers of the New Jersey prison object to the
holding of executions within the prison walls. The reasons
of this objection are that such events in the prison have a detri-
mental effect on the prisoners in general. The report favors
a building in the State set apart for the purpose of executions.

Extension of Parole System Suggested. — The New Jer-
seyites suggest that their parole system in prisons and reforma-
tories be enlarged, so that parole inmates be under the supervision
of a sufficient number of parole officials.

BOOK REVIEWS.

Alcoholism and Idiocy. — Le Marc'Hadour quotes Tur-
ner^ remarkable case as follows: the first three children, of
parents who were alcoholists were born idiots. The parents then
corrected their habits, and did not use any alcoholic drinks for
some few years. Two children were born during that time of
parental temperance, and both children were intelligent and
active. The parents again became intemperate in the use of
alcohol, and two more children were born during the new period
of their intemperance. Both of these children were idiots
(CriminaMte de I'Enfance, These, Rennes, 1903).

A Comparative Study of Idiopathic Epilepsy in Animals
and flan. — Dr. L. Pierce Clark: A number of cases of
idiopathic epilepsy in domestic animals and birds are quoted
from various sources and one personal case of the disease in
a canary bird is published (New York Medical Journal, etc.,
December 10, 1904).

Princess Louise's Examination. — According to the New
York World, November 6, 1904, Dr. Bachrach, representing
Prince Philip, of Coburg, announces officially the scope of the
examination of Princess Louise by Drs. Magnan and Gamier.
The court will judge whether her mental condition permits her
to manage her property.

BOOK REVIEWS.

Trattato di Psichiatria ad Uso Dei Medici e Degli 5tu-
denti. With numerous figures in the Text. Prof. Leonardo
Bianchi, Director, Psychiatric and N euro pathological Clinic,
Royal University, and of the Hospital for the Insane, Naples.
Pasquale, Naples, 1904. The preceding two parts of this work
were analyzed in previous issues of this Journal. The present
is the third and last part of this excellent text-book on psychiatry.
The first chapter is devoted to the exposition of methods of
examining the insane. The advice given in this regard is all
that can be desired : every detail there indicates the author's long
experience and practical knowledge of the insane in all their
phases. The chapter on classification of insanities again indicates

BOOK REVIEWS

the author's broad points of view : he shows the shortcomings of
an empirical classification, of that based on anatomopathology,
etc. For want of a better classification, he chooses the happy
medium between the French and German, — one based on the
teaching of degeneracy, and the other on the various degrees of
cerebral development. The various clinical forms of psychoses
are masterfully traced in a broad and truly scientific way : there
is no appearance of any routine in the presentation of the clinical
varieties; every psychosis is considered in its relation to the
latest discoveries and researches, giving the reader not only a
certain clinical picture of psychoses, but also enlarging his point
of view on the relation of disease to society in general. The
chapter on delinquency is handled on the broadest possible lines.
We have accustomed ourselves to consider delinquency in its
primitive relation to criminal anthropology, the author says, but
the study should be vastly enlarged and also considered in its
relation to sociology and psychology. He then indicates how
readily we can find reckless delinquents in the higher walks of
life — among the administrationists, etc. The "superior degen-
erate" of Magnan is understood by a few only, and Prof. Bianchi
sees this degenerate in the full signficance of the term. The
entire scale of clinical psychoses is presented in an excellent
manner. This is one of the best text-books on psychiatry of
to-day. Prof. Bianchi has injected into this work the results of
all the advantages he has had in his psychiatric career — those of a
scientist, clinician and medical journalist.

The volume contains 844 pages. Price $2.00.

Mental Defectives. Their History, Treatment and Train-
ing.— Dr. Martin W. Barr, Chief Physician, Pennsylvania
Training School for Feeble-Minded Children, Elwyn, Pa. Illus-
trated by 53 full page plates. P. Blakiston's Son & Co., Phila-
delphia, 1904. The first chapter treats of the synonyms and
definitions of mental defectives. The next chapter, comprising
some fifty pages, is devoted to the history of the progress in the
treatment of mental defectives. Valuable and inspiring
paragraphs are to be found in this chapter: — The influ-
ence of Boerhaave, Morgagni Haller, Jean Jacques Rousseau,
Jacob Rodrigues Pereire and others, on the conception of educa-
tion and training of the human mind is vividly presented ; and
their theoretical and practical efforts in instituting facili-
ties for educating mental defectives is well described. The

54 BOOK REVIEWS.

gradual development of quality and number of institutions for the
treatment and care of defectives is considered, and a list of such
institutions as they exist to-day is given. Classifications of mental
defectives as given by various authors are examined, and the
chapter following treats of the etiology of the affections in ques-
tion. The author is quite conservative in his opinions on certain
causes of idiocy and imbecility, especially in regard to alcoholism.
He freely presents, however, opinions of authors from all parts
of the world, where the subject is studied, giving the reader a
complete list of causes and possible causes of mental defective-
ness. Speaking of the death periods, he points out that the largest
number of deaths occur between the tenth and twentieth years;
but comparatively few pass the twenty-fifth year, and exceptional
cases appear from thirty to forty years. Craniectomy and
asexualization are presented in their true clinical significance.
The general and special treatment of the defectives, as presented
by the author, show that he is an experienced clinician.
The price of this volume is $4.00.

Le Role Du Sel En Therapeutique.^-DR. Ch. Achard,
Agrege, Faculty of Paris. Monographie No. 40, Masson and
Co., Paris, 1904. This monograph is the second part of mono-
graph No. 39, — "Le Role du Sel en Pathologie," reviewed in
this Journal, Vol. VI, Nos. 3-4. The present monograph deals
with the question of salt in therapeutics. The amount of salt we
absorb daily with our food is 2 grammes. This amount of salt
is utilized by the tissues in various ways, and one part of it
serves in the cells as a protective agent against various poisons.
The maximum amount of salt that may be absorbed without dan-
ger to the economy is 15 grammes. An excessive use of salt
may, in the long run, affect the kidneys to a more or less marked
degree. The question of the amount of salt in the system is of
great importance in cases of hydropsia: a chlorurated or hy-
pochlorurated diet may determine the issue of the disease. De-
tailed considerations are given on the conditions that require
chloruration or hypochloruration. Hypochloruration is also
applied to-day for the purpose of increasing the effect of certain
drugs — as that of the bromides in epilepsy. For reason of its
affinity with water, salt renders valuable service in replenishing
the vessels after depletion due to hemorrhages, diarrhea, etc.
The important role of salt in the economy is based on its rela-
tively simple and, mostly, physical action.

BOOK REVIEWS.

The Youth of Washington Told in the Form of an Auto-
biography.—Dr. S. Weir Mitchell. The Cenjtury Co.,
New York, 1904. This biography is particularly interesting be-
cause it puts Washington vividly before our minds as he was in
reality during his times. As the title of the book indicates, the
biography is written in the form' of an autobiography. The
labor involved in putting together material culled from auto-
biographic notes of Washington himself and from other sources
can hardly be appreciated. The work is so well done that this
volume treating of Washington is probably the most valuable
one on the subject we possess. There lis excellent reading ma-
terial in this book for the young and the old of all nations :
every page of the book fairly breathes forth the manly, the ideal
of the father of this country.

As for Dr. Mitchell's part in this work, — it need simply be
remarked that whatever comes from his pen is always full of
manliness and inspiration. ,

Geschlecht und Kinderliebe Dr. P. J. Moebius. Carl Mar-
hold, Halle a. d. S., 1904. A comparative study of child-love
in man and animals is made. In the female, child-love is more
developed than in the male. The author fully believes in a
cerebral centre of child-love and upholds Gall's teachings in
this regard. A special chapter is devoted to the study of child-
love in its relation to cranial form. Thirty-five illustrations of
cranial forms are presented. The opinion is given that the oc-
cipital region is the seat of the child-love bump. The latter
is more marked in woman than in man. It is suggested that it
is more appropriate to call the "fair sex" the "child-loving sex".
Among civilized people child-love may also be marked in man,
and the latter' s occipital region may be found more developed
than normal.

Ueber den Moralischen 5chwachsinn des Weibes. — M-me.
Katinka von Rosen. Carl Marhold, Halle a. S., 1904. — Woman's
morality has room for improvement, the author claims, and the
pamphlet is written for the purpose of showing wherein the par-
ticular weakness of woman lies. The defective morality of woman
is also responsible, in a large number of cases, for criminal acts of
man. "Cherchez la femme" is the war cry. As authority for her
statements, the author claims her experience during some sixty
years of her life as wife, mother and, perhaps, grandmother.

56 BOOK REVIEWS.

A Collection of Neuropathological and Psychiatric Works
Dedicated to Prof. I. A. Sikorski on the Occasion of the
Completion of Thirty-five Years of His Medico-Scientific
Career, — (1896-1904). By his students, Kushneriev, Kiev, 1904.
A number of valuable papers on neurology and psychiatry cover-
ing 800 pages are collected in this volume. This conceit of honor-
ing a Professor is delicate in sentiment as well as useful in sub-
stance.

Le Voriazione Dei Sulchi Cerebrali e la Loro Origine
Segmentate Nell'Hylobates,— Dr. Sergio Sergi : The first part
of the monograph treats of the comparative and critical analy-
sis of the cerebral sulci in the individual and species of the
genus Hylobates. The second part is devoted to the consideration
of the segmentary origin of the cerebral sulci and their variation
in the individual and species. Illustrations accompany the study
(Laboratorio di anatomia normale, R. Universita, Roma, Vol. X,
fasc. 3, 1904).

Tuberculosis as a Disease of the Masses, and How to
Combat It. — Dr. S. A. Knopf. Firestack, New York, This
essay won the prize offered by the International Congress to
Combat Tuberculosis as a Disease of the Masses. Its main merits
are conciseness, practicability and applicability. The world seems
to have appreciated these traits: the essay has been translated
into every living language. Every one interested in the fight
against the "white plague" will find this essay of interest.

Criminalite de L'Enfance. — Rene Le Marc'Hadour.
These, Rennes, 1903. The causes of criminality are considered
from various points of view, and the social struggle against
criminality is examined. Special consideration is devoted to the
question of mentally and morally invalid parents in relation to
their offspring. Technical reforms are suggested for France.

Des Alienes Criminels et Des Crimnels Alienes.— Marcel
Verin. These, Rennes, 1904. The author considers the classi-
fication of the criminal insane and the insane criminal, and their
responsibility before the law and community. The question of
special hospitals or establishments for these subjects is analyzed.

The Journal of Mental Pathology.

Vol. VII. 1905. ' No. 2.

THE DEGENERATE EAR. ANATOMO-ANTH-
ROPOLOG1CAL SKETCH.

By Dr. V. V. Vorobieff, Moscow.

The study of the "degenerate ear" was started at about the
same time as that of psychical and physical degeneracy. Morel
( 1 ) , among others, mentioned, among other peculiarities of physi-
cal signs of the degenerate, the anatomical anomalies of the ear
shell. He himself did not enter into any detail on the subject,
but simply remarked that the structural anomalies of the ear
could be divided into three groups :

1. Abnormal implantation.

2. Hypertrophy or atrophy of the various parts of the ear shell.

3. Rudimentary union of the individual parts of the external
ear and even absence of those parts (helix, anti-helix, anti-tragus,
etc.).

In 1859, soon after the publication of Morel's papers on
the subject, Stahl (2) published a paper on the anomalies of the
individual parts of the ear shell. Legrand du Saule (3) was the
first psychiatrist to devote some pages to the subject in question
in his textbook on psychiatry. He then indicated the imperfect
development of the helix and other parts of the external ear as
being stigmata of degeneracy. Then followed Griesinger and a
number of other German, French and Russian authors — all de-
voting some space in their textbooks to the consideration of the
"degenerate ear." Most of the authors simply repeated one an-
other's statements, indicating as signs of degeneracy an adhering
or undeveloped ear-lobule, an undeveloped helix, prominent anti-

58 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

helix (Wildermuth's sign) (4). Later were pointed out the
standing out ear (Lombroso's sign) (5), Darwin's ear (Grade-
nigo) (6), etc.

It is well to remark that the authors in question did not show
any critical analyses regarding the matter in hand, remaining
content to borrow one another's opinions as alluded to above.
Otherwise it would be difficult to explain the fact that in the
textbooks of these authors adherence of the pinna, for instance,
should be indicated as a positive sign of degeneracy, whereas no
independent study of the comparative frequency of this defect,
among the sane and insane respectively, is presented by any of
them. Even the most enthusiastic advocate of the "degenerate
ear," Binder (8), has not presented any study of this subject.
According to him, psychiatrists found some 30 per cent, or more
of adherent lobules among the insane.

Beginning with Lombroso's teaching and that of his followers,
the Darwin ear and other anomalous forms, especially the pro-
truding ear, is frequently found among criminals. The per-
centages of the various anomalies vary with the authors. The
percentages of the standing out ear are given as follows : Lom-
broso, 28 per cent, of his cases (394 cases) ; Marro, J.J per cent.
(529 cases) ; Penta, 3.5 per cent. (400) ; De Sarlo, 5 per cent.
(80) ; Stura and Arese, 16 per cent. (19 cases) ; Gradenigo, 25.2
per cent. (200), etc.

Neither the authors cited above nor those as yet to be cited
give their studies of the ears of normal people. Consequently, the
conclusions as regards the "degenerate ear" among the insane
and degenerate respectively must be accepted on the basis of
faith only.

In 1886, Fere and Seglas (9) presented a more acceptable
statistical study of some particular forms of ears of the insane
and criminals, but they made no attempt to describe the "degen-
erate ear." Wildermuth's (4) work appeared at about the same
time, treating of some peculiarities of the ears of idiots and epilep-
tics, in whom the anti-helix is unusually prominent. Binder
termed this form Wildermuth's ear. Rohrer's work (10) be-
longs to the same period, his last work (11) dating from 1897.
Lannois's work (12) came out in 1887 and his last work (13)
in 1892. In this last work he is full of skepticism regarding the
teaching of the "degenerate ear" of the criminal as described; by
Lombroso and his pupils. He presents comparative studies of
healthy people and criminals. Unfortunately, Lannois himself
makes the comparison between Italian criminals and French nor-
mal inhabitants, ignoring the possible influences of race on the

THE DEGENERATE EAR— Dr. Vorobieff.

particular structure of some of the ear. That race has an influ-
ence on the structure of the ear is demonstrated by Topinard
(14), — putting together the facts brought to light by Schwalbe
(15), Karutz (16, 17) and myself (18).

In 1888, Frigero's work (19) appeared. He limits himself to
describing some particularities, leaving a rather vague notion
as to what forms of the ear should be grouped as "degenerate."
Nevertheless, his work is interesting because, as an ardent follow-
er of Lombroso's School, he was the first to introduce into the
study of the "degenerate ear" embryologic data and those of com-
parative anatomy. The ears studied were those of children, adults
(soldiers), insane, criminals of various classes and, finally, those
of ten monkeys (no mention is made of the varieties). Frigerio
was also the first to draw attention to the ear measurements in
addition to their general description. At about the same time
appeared the work of an ear specialist familiar with the anatomy
and embryology of the ear — Gradenigo (20). His first paper
'dealt with the normal external ear and the subsequent papers
were devoted to statistical data regarding the morphology of the
external ear especially of insane men and women. In this com-
parative study he indicates what, according to him1, should be
considered a "degenerate ear." His is the first work in which an
attempt is made to present a general and at the same time com-
plete analysis of the question ; besides, it has the merit of being
the most methodic research into the question. In 1889 appeared
Binder's extensive work Das Morel'sche Ohr, — full of errors
of method, but interesting nevertheless because an attempt is
made in it to classify all forms of the "degenerate ear" (Morel's).
It seems that he was not familiar with Gradenigo's work. Not
being familiar either with the embryology or the anatomy of
the external ear, however, Binder made up an artificial classifica-
tion that resulted in an irregular and arbitrary placing of similar
genetic forms in different groups. In 1889, a^s0 appeared Julia's
(21) witty and well founded criticism of Binder's work. Julia
pointed out that it was not reasonable to compare the ears of
old criminals or of insane with those of normal young men (sol-
diers), and drew attention to the inadequacy that characterized
the study of the ears of normal people, and the lack of uniformity
of method with which the individual forms of ears had been
studied by various authors. He objects especially to the teach-
ing of the atavistic variety of the "degenerate ear," some of which
present simply arrested development, while others, on the con-
trary, present an excessive development of the helix {helix bandi-
formis) , prominent anti-helix, etc. He also pointed out that there

6o THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

existed racial as well as caste forms of ears. That even the mode
of wearing one's head-gear had an influence on the form, of the
ears, some compressing them and thus changing their shape. In
children the shape of the ears also depends greatly on the mode
of feeding (lying on the side, etc.). He thus leads to the con-
clusion that even when a comparison of the ears of criminals, in-
sane and healthy people is made, the results are not quite positive
and it is a matter of doubt whether the anomalies found are stig-
mata of degeneracy or curious forms of development due to
various conditions as alluded to above.

Julia was not the only skeptic on the subject. Later investiga-
tors founded their criticism on facts studied and ferreted out by
themselves. Lannois was one of these, as was mentioned above.
Then, there was Ganter (22) ; on the basis of his personal in-
vestigations he could not justify the denomination of "degenerate
ears" because, he said, the study of the ear had not been made
properly in normal man. Nsecke (23) is also skeptical regarding
the peculiar ear structure of criminals and insane. He thinks,
with Sommer, that the only conditions of the ear that should be
designated as degenerate are those causing functional impair-
ment. Schaeffer (24) and especially Schwalbe (25-29) brought
to light the invalidity of the teaching of the "degenerate ear/'
Schaeffer does not touch on the subject of the degenerate ear:
he simply makes a study of ears of the normal German popula-
tion and finds various percentages of embryonic non-develop-
ment, varying with the geographical position of the countries in
which the population was studied. These percentages vary be-
tween 25 per cent, and 60 per cent. And the embryonic defects
pointed out by him in the normal population quite correspond to
the "degenerate" forms of various authors. It is interesting to
note that the most ardent adepts of the "degeneracy" theory also
give from 25 per cent, to 60 per cent, of degenerate ears among
the insane — the same percentage of embryonic defects of the ears
that Schaeffer (30) found among the normal adult German
population. Analyzing some of the forms of the "degenerate
ear," Schwalbe points out that Darwin's ear is so common that
it cannot properly be called an anomalous ear. He further points
out that in man the embryonic development of the ear is charac-
terized by a process of reduction (reduction of the pointed ear
common to many animals). This reduction is also characteristic
of the development of the ears in monkeys. The degree of reduc-
tion, however, is not proportionate to the height of development
of beings, for the reduction is most marked in the orang-outang.
From this may also be drawn the conclusion that an undeveloped

THE DEGENERATE EAR— Ds. Vorobieff. 6l

ear in man does not at all indicate an atavistic condition of its
owner.

Recently Karutza's work (16) appeared dealing with the racial
forms of the ear, also giving personal observations of ear forms
of normal and insane Germans. He concludes by stating that a
review of the works on the subject fails to convince that the ear
called degenerate is more prevalent among criminals and insane
than among normal subjects. Anatomo-anthropologic and psy-
chiatric study of the "degenerate ear" leads me also to similar
conclusions. I have had occasion to express my views in extenso
in my monograph entitled The External Ear of Man, Moscow,
1 901.

In my study of normal people there were 325 adults, laborers
of the Moscow factories, 100 women factory workers, — all born
in Riaziansk, 80 boys and 80 girls between 6 months and 16
years of age, born in the Department of Moscow ; 100 insane
born in the same Department. All the subjects were of the
peasant class. Finally, I included in my studies 75 Kalmucks
(Mongolians), living on the Volga, near Astrakhan. I was
guided in my researches by Schwalbe's schema (28) that had just
appeared at that time (1895), indicating how to study the ear
shell.

My conclusions from the main works on the subject and from
my own observations are the following:

The ear shell of man undergoes marked changes as age ad-
vances : the changes apply not only to the size but also to the
form of its individual parts. The changes of the individual parts
tend to a reduction of the embryonic form (changes designated
as degenerative by most psychiatrists) that are most marked in
children and least marked in the old.

There are positive data regarding racial variations of form of
the ear. These data are as yet not sufficiently studied, and we are
not enabled by them to establish even a general ethnologic group-
ing according to the appearances of the ear shells. Nevertheless,
some of the variations of the forms of the ears indicate their de-
pendence on racial groups ; many anthropologists, psychiatrists
and criminologists have declared ears to belong to the "degen-
erate" group when their forms differed from those they had in-
dividually chosen as normal forms. Thus, the authors declare
the ear to be "degenerate" when the helix is undeveloped, when
the ear corresponds to Darwin's ear, when the lobule is adherent,
especially when the lobule is long and triangular, forming an
acute angle with the cheek (group I according to Schwalbe's
schema, etc.).

THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

In the table below are given the main traits of the ear in three

main branches of man.

Description of Negro ear. European ear. Mongolian ear.

ear.

1 Length Small. Medium size. Large.

2. Physio - path- Large (broad Medium. Small (narrow
ologic index: ear^' ear^
relation of

breadth to
length.

3. Darwin's ear. Compara- Often marked Rare.

tively rare. variations for

different
groups.

4. Helix. Well developed. Underdevel- Well developed.

oped as com-
pared with the
negro.

5. Lobule. Less adherent Adherent lobules Adherence is

than in other frequently met chara cter-

races. with. Simple istic, Group I.

adherence pre- of Schwalbe:

dominates. long, narrow

lobule, joining

the face at an

acute angle.

Speaking of the "degenerate ear," Karutz says that he knows

of no study of ears of criminals and insane that is free from

errors of method.

The erroneous views regarding the "degenerate ear" as pointed

out by a few authors, Julia and myself are as follows :

1. Lack of comparison between pathologic and normal groups
and the purely theoretic assertion that given peculiarities of the
ear do not exist in normal subjects (this is particularly applicable
to Binder's statements).

2. The racial peculiarities of structure are neglected when
comparing groups of subjects. Social and economic differences
are also neglected. Finally, the ages of the subjects are not taken
into consideration. In order to demonstrate the influence of age,
I present below data regarding the length of ears of normal and
insane Russians of the North (Velikorussy), according to my
special investigations :

The average length of an ear of a normal Northern Russian is
61.4 mm., while that of an insane subject is somewhat longer, —
63.1 mm.

The measurements of the ears according to the ages of Rus-
sians (Velikorussy) are given in the table below:

YEARS. NORMAL. INSANE.

From 26 to 30 6i.imm. 6i.6mm.

From 31 to 35 62.0mm. 61 .8mm.

From 36 to 40 63.1mm. 63.5mm.

From 41 to 45 63.3mm. 63.5mm.

From 46 to 60 63.4mm. 63.5mm.

THE DEGENERATE EAR— Dr. Vorobieff. 63

Thus it appears that there is no difference in length when con-
sidered from the latter point of view. If the average is some-
what more marked for the insane, it is simply beause the latter
happened to be of higher stature.

3. Comparatively unusual ear forms are counted as being "de-
generate" ; it goes without saying that such conclusions are er-
roneous.

4. Almost all the authors who have published comparative stu-
dies of ears in normal and insane subjects respectively have fol-
lowed a method that I should call a method of preconceived anom-
alies ; almost every author in question seems to base his ideas on
previously published literature on the subject. As our knowledge
of the normal ear is most meagre, however, nothing warrants our
conclusions that this or that form of the ear is a stigma of de-
generacy. We should certainly look first for variation of form
according to race, individual age, etc., otherwise the term "degen-
erate ear" loses its meaning. In the study of the ear it is essen-
tial to first become familiar with the form of the normal ear.

5. No importance is attached to the insignificance of size as
explained above, whereas considerable importance is attached to
differences between particular parts of the ear as found among
different populations. These differences may, under normal con-
ditions, vary even with similar ethnic groups. And these differ-
ences are generally far more marked than are those pointed out
by authors when comparing forms of ears among normal and
insane populations.

For the purpose of clearness, I take the liberty of presenting
some of the distinctive traits pointed out by various authors as
particular stigmata of degeneracy. I wish to remark at the out-
set that Schaeffer, while searching for other data than those re-
garding the "degenerate" ear, came across distinct variations in
his findings among normal populations. His neutral attitude is
a guarantee in itself of his unbiased mind on the subject. He
found that the percentage of adherent lobules or those joining
the face at an acute angle, varied in Germany according to the
population — between 20 and 36 per cent. — a difference of 16 per
cent, in some cases ; whereas this difference between the Italian
normal and insane populations is only 4.5 per cent. (Gradenigo:
normal, 5.2 per cent. ; criminal, 7.6 per cent; insane, 9.7 per cent.)
Vali gives the following figures for Magyars : normal, 5.6 per
cent. ; insane, 13.6 per cent. — a difference of 8.0 per cent., etc.

Schaeffer found the following data regarding the non-develop-
ment of the helix among various German populations :

THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

Bonn, 5.9 per cent. North Baden, 13.0 per cent.

Reiningen, 11.0 per cent. Middle Rhine, 15.0 per cent.

Schwabia, 1 1 .0 per cent. South Baden, 36.0 per cent.

Gessen, 11.5 per cent.

In South Baden there were only 50 cases studied, while a much
larger number was chosen for the other groups.

In face of the above quoted differences in percentages among
normal populations, the comparative percentages obtained be-
tween normal and insane populations lose all their significance.
Thus, Zembi (Zurich) gives for the normal population 1 per
cent. ; for the epileptic, 3 per cent. ; for the normal, 0.8 per cent. ;
for the insane, 3.8 per cent. ; and for the criminals, 4.0 per cent,
Vali (Buda-Pest), normal, 3.2 per cent. ; insane, 9.7 per cent.

For the German groups mentioned above, Schaeffer finds Dar-
win's ear for the normal population between 13 per cent, and 47
per cent., and by excluding the South-Baden group, that is a small
one, — between 13 per cent, and 30 per cent., whereas the differ-
ence of percentage between the normal and pathologic popula-
tions is much less marked, as seen below.

AUTHORS.

DARWIN S EAR.

Zaubi (Zurich),

normal,

3.O %,

pathologic,
idiots,

44%.
6.0%.

Naecke (Germany),

normal,

1.25%,

insane,

II.O%.(*)

Gradenigo ( Italy ) ,

normal,

3-5 %,

criminal,

3-3%-

Fere and Seglas

(France),

normal,

2.4 %,

insane,

4.1%.

Vali (Buda-Pest),

normal,

3.0 %,

criminal,
insane,

4-5%.
6.4%.

Analogous figures could be presented as regards other pecu-
liarities of the ear. Unfortunately, the number of observations
is not sufficient or else the authors have a tendency to exaggerate
their data. Such a tendency is evident in Binder's case, for in-
stance (Das Morelsche Ohr) ; speaking of the peculiarity of the
ear structure among the insane, he says that the peculiarity is
so marked that one hardly ever finds it among normal people
one meets on the street, in cars, in trains, etc. Yet, as we have
seen, Schaeffer, Schwalbe and others, who also made their studies
among Germans, and in some instances, perhaps among the same
German populations that Binder had studied, or looked at in
the streets, etc., readily found some of Binder's signs to the extent
of 40.0 per cent.

Limiting myself to the consideration oif the adherent lobule,

* Although the difference is quite marked, Naecke himself does not
attach to it any importance.

THE DEGENERATE EAR— Dr. Vorobieff.

Darwin's ear and undeveloped helix, — all of which have been
studied in normal populations, and that are most readily called
by psychiatrists stigmata of degeneracy, I shall point out the
following facts : among normal populations these anomalies are
quite as prevalent as they are among the insane or criminals.
Among normal populations a marked difference of percentages
is found not only between different groups, but also within the
limits of the same groups. Schaeffer's figures in this respect
were shown above. The figures below are those obtained by
various authors :

Adherent Lobule.
Group I, Group II, Groups
simple ad- I -f- II.
herence.

Nationality.

France.

Italy.

Germany.

Russia

(Velikorussy).

Russia

(Kalmucks).

Authors.
Lannois.
Fere and Seglas
Gradenigo.
Karutz.
Schaeffer.

Vorobieff.

according to
Schwalbe.
Adherence
at an acute

angle.
Per cent.

5-6

• 5-5
5-2
2.0

[37

Per cent
IO.8
18.7
21.3

23.3

21.7

50.9

5-3

Per cent.
16.4
24.2

26.5

25.3
20.36

354
56.2

Nationality.

French.

Italians.

Magyars.

Germans.

authors. Maldevelopment of the helix.

Fere and Seglas, 5.5%

Lannois, 8.0%

Gradenigo, 0.8 (among women, 7.3%).

Vali, 3.2%

Naecke, 10.0%

Karutz, 13.9%

Schaeffer, 5.9 to 36.0% (by exclusion of

this as not sufficiently nu-
merous— 5.9% to 15.0%).
7.5% (of less marked forms
there are 40%).
Kalmucks. Vorobieff, 14.3% (less marked forms—

12.5% and more).
I do not cite corresponding data for the insane. Vali (Buda-
pest) found the most striking differences in this respect between
normal and pathologic populations, as shown below:

Normal, 3.2 per cent. ; idiots, 86.0 per cent. ; insane, 9.7 per
cent. These differences are less marked according to others. But
even Vali's marked differences lose their absolute significance

Russia

( Velikorussy) . Vorobieff,

66 THE JOURNAL OF MENTAL

PATHOLOGY. Vol. VII, No.

when compared with

Schaeffer's data

obtained among simil;

populations.

Darwin's Ear.
Per cent, of

Country or Nation.

AUTHORS.

marked forms.

Magyars.

Vali,

3.0

Italians.

Gradenigo,

3-5

Kalmucks.

VorobiefT,

3-7

French.

Fere and Se

glas, 2.4

French.

Lannois,

14.0

Russia.

(Velikorussy).

VorobiefT

13-5

Germany.

(Elsace and provinces

along the Rhine).

Schwalbe,

30-7

Upper Elsace.

Schwalbe,

36.0

Here we see again that there is no absolute standard for normal
populations.

I shall now present my personal comparative studies of the ears
of normal and insane Russians (Velikorussy). In these studies
I am guided by Schwalbe's schema that is quite complete and defi-
nite in its groupings. I shall present my comparative data in
Qxtenso only as regards the traits that have been considered by
authors as stigmata of degeneracy.

In Schwalbe's schema the main traits of the ear are classified
in three groups: group I — underdeveloped ear; group II — 'badly
developed, ear and group III — markedly degenerate ear.

Russians (Velikorussy).
Normal. Insane.
Per Cent. Per Cent.
Darwin's ear, group I-II,
Helix markedly underdeveloped,
Helix not sufficiently developed,
Helix completely developed,
Anti-helix protruding outwards

(Wildermuth's ear),
Adherent lobule, group I (acute angle),
Adherent lobule, group II,

(simple adherence),
Standing out ear,

From the above table it is seen that the peculiarities generally
accepted as stigmata of the degenerate are also quite marked
among normal people. The percentage of subjects who are free
from the stigmata here considered is 23.5 per cent, among the
normal and 22.0 per cent, among the insane. In other words,

13.5

18.0

13.0

40.6

35-5

52.0

5i-5

30.1

23.0

137

20.5

21.7

20.0

10.4

35-o

THE DEGENERATE EAR— Dr. Vorobieff. 67

there is no difference in this respect between the normal and the
insane Russian populations (Velikorussy). As regards the par-
ticular differences that do exist when comparing the ears of the
normal and insane of this population — they are too small to be
of any significance. Thus, for instance, among the insane (Veli-
korussy) Darwin's ear occurs 4.5 per cent, more frequently than
among the normal subjects. As the same ear is found to the
extent of 13.5 per cent, among normal subjects, however, the dif-
ference may be explained by some defect in the method of com-
parison.

Nor is there any difference in degree of development of the helix
as compared between the normal and insane Russians (Veli-
korussy). It is true that the percentage of markedly underdevel-
oped helixes among the insane is almost double that among nor-
mal subjects (13.0 per cent, for the insane, 7.4 per cent, for nor-
mal subjects). The difference between the two forms of the
helix, however (markedly underdeveloped and not sufficiently de-
veloped) is not distinctly indicated. It is possible, therefore, that
in the case of the insane, when some doubt arises as to the group-
ing of the form, preference is given to the more imperfect group,
while in that of normal subjects the anomaly is grouped prefer-
ably as not sufficiently developed. It is far easier to draw conclu-
sions from the percentages of the completely developed ear of the
normal and insane populations respectively. In this case there is
no difference to speak of (insane — 51.5 pet cent, normal — 52.0
per cent. ) .

The difference is somewhat more evident as regards the adher-
ent lobule (Schwalbe's group I, joining the cheek at an acute
angle) (*.). For normal subjects we have 13.7 per cent, and for
the insane 20.5 per cent. But even here, the difference is not so
very marked.

The percentages regarding the standing out ear (Wildermuth's
ear) are quite reversed: 30.1 per cent, for normal subjects and
23.0 per cent, for the insane. I do not feel inclined to conclude
from these figures that the degenerate (Wildermuth's) ear occurs
more frequently among normal than among insane subjects. It
is most probable that this form of ear is equally frequent in both
populations. The only conclusions that can be drawn from this
is that the form in question is not as rare as one may be led to
suppose.

Among the Russians (Velikorussy) the relative proportions of

* Simple adherence (Schwalbe's group I.) appears in similar percent-
ages for normal (21.7 per cent.) and insane (20 per cent.) subjects re-
spectively.

68 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

the standing out ears are quite striking: 10.4 per cent, for the
normal and 35.0 per cent, for the insane population.

Schwalbe considers the ear as "standing out" when its pos-
terior surface forms with the skull an angle of 90 degrees. Even
under these precise conditions flagrant mistakes are possible : when
applying an instrument between the ear and the skull for measur-
ing the angle, it is quite easy to be misled by insane patients' state-
ments while taking the measurement and thus increase the angle
more than it is. However, the difference is so striking that it should
not be ascribed entirely to this possible condition. It is more
likely than not that the difference exists in reality. It may be
remarked in this connection that Lombroso and his followers con-
sider the standing out ear as one of the most characteristic head
features of criminals. It is possible that the junction of the ears
at right angles in the insane and criminals is a stigma of atavism
(see, for instance, the angle of junction of the ears in the majority
of animals) or else it may be due to the persistence of embryologic
forms. Standing out ears are frequently found in rachitic sub-
jects, particularly in those having begun to walk Jate or having,
during childhood, spent a good part of the time in bed. Under
those conditions, it is not so much the actual ear that is standing
out as the corresponding part of the skull that is flattened.

There can be no doubt that criminals and a large number of
insane live in conditions of poverty and privation. It may be
supposed, therefore, that rickets play an important part in the
changes of the ear shell of the insane through weakness during
infancy. To my regret, it did not occur to me in proper time to
look for signs of rickets in the subjects I had studied.

The history of the embryonic development of the ear shows that
almost all the forms corresponding to the so-called "degenerate"
varieties are met with at some or other stage of development.
Darwin's ear in its various forms, for instance, may be seen in
the normal fetus of from 5 to 7 months of age, then the tuber-
cles undergo a process of reduction, leaving, nevertheless, traces in
a considerable number of adults. Adherence of the lobule is also
of embryonic origin, the detachment commencing between the
fifth and sixth months of fetal life. At about the same time or
somewhat later begins the curving of the helix in its lower part
(in its upper part the process begins at the end of the third month
of fetal life) , etc.

This "degenerate" form of the ear represents various degrees
of arrest of development. Hence the question arises, — does not
degeneracy of the ear indicate that there is a tendency to degen-
eracy of the body in general and of the nervous system in partial-

THE DEGENERATE EAR— Dr. Vorobieff. 69

iar? The idea is seductive in its theoretical meaning. Yet exist-
ing facts do not speak in its favor. Schaeffer's researches into the
frequency of persistence of embryonic imperfections of the ear
in adults show that the imperfections are found in from 65 per
cent, to 75 per cent, of normal subjects. His researches cover
several thousand 'normal subjects. It is noteworthy that among
the insane some psychiatrists found the various embryonic imper-
fections of the ear to the extent of from 60 per cent, to 65 per
cent. This percentage is even somewhat smaller than is that ob-
tained by Schaeffer among normal subjects. This may be ex-
plained by the fact that Schaefrer studied the embryonic condi-
tions, leaving aside the question of the degenerate ear ; and while
doing so, he possibly took for embryonic forms certain varieties
not considered by the majority of psychiatrists as degenerate.
Thus, for instance, a conic form of the tragus (its normal shape
is quadrilateral) is not considered as a stigma of degeneracy,
although Frigerio does consider it as such. The so-called satyr
ear is another form that is taken into consideration by the embry-
ologist, but is not considered by the psychiatrist (see Schwalbe,
Schaeffer and my own paper on the outer ear). This may also
increase the number of the embryonic forms ascribed to normal
populations as compared with degenerate forms ascribed to de-
generate populations.

Considering that it was difficult to obtain uniform results when
the methods of investigation were so diverse, I undertook to follow
as uniform a method as possible in my studies, choosing both nor-
mal and pathologic groups as nearly similar as possible as regards
nationality, social standing, birth and occupation. The subjects
were Russians (Velikorussy). I found that perfectly normal and
well developed ears (among men) were found only in 23.5 per
cent, of the normal subjects. The corresponding percentage
among the insane is about the same — 22.0 per cent. These figures
indicate that the embryonic forms of the ear are quite prevalent
in the adult, and these forms cannot be said to have any signifi-
cance as regards the degeneracy of the subjects.

It should be concluded, therefore, that the outer ear in man
is a rudimentary organ and has no particular significance (see
Schwalbe) (*) in his functional life. The ear steadily under-
goes a process of reduction that is not quite complete in many
cases; the external ear being almost a useless organ in man,
nature seems to neglect its process of development.

* Schwalbe and others show that more or less pointed ears are found
in animals in which the sense of hearing is highly developed. Further
studies show that a reversal of the process of evolution of the ear char-
acterizes the ears nearing in shape those of man — the process being that
of reduction.

70 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

From the figures cited above it is seen that the process of reduc-
tion is sometimes quite imperfect. The signs of underdevelop-
ment are particularly evident when examining specific parts of
the ear (imperfect reduction). Thus, in normal subjects (Veli-
korussy) one trait of underdevelopment of the ear is found in 225
cases; two in 151 cases; three in 91 cases; four in 19 cases; five
in 9 cases, and even six in 3 cases.

I class all the groups as follows :

1. With one trait of underdevelopment — transition group of
ears.

2. With two traits of underdevelopment — underdeveloped ear.

3. With three or more traits — markedly underdeveloped ear.
Comparing the frequency of these forms among the normal and

insane subjects respectively (Velikorussy), I found the follow-
ing results :

NORMAL. INSANE.

Per Cent. Per Cent.

Group of perfectly developed ears 23.5 22.0

Transition group 34.6 36.5

Underdeveloped 23.2 23.5

Markedly underdeveloped 18.7 18.0

The above data show how prevalent the embryonic form of
ears is among normal subjects and the absence of difference
between the similar percentages among the insane. It follows,
therefore, that the embryonic forms of ears, described by psychiat-
rists as "degenerate" ears, have no significance as stigmata of de-
generacy.

To further argue the matter on the basis of material personally
studied, I suppose, for the sake of argument, that the embryonic
forms of ears indicate that their owners are degenerate. Then it
must be concluded that a large number of normal Russians (Veli-
korussy) are degenerate to a marked extent. But Schaeffer's,
Schwalbe's and others' figures also show a large percentage of
embryonic ears among the normal German populations. There-
fore, such a conclusion cannot be correct.

To be still more precise in the matter, I reasoned thus : if the
usual traits of the ear (underdeveloped helix, standing out anti-
helix, Darwin's ear, adherent lobule, etc.) are to be accepted as
stigmata of degeneracy, then subjects with such ears should pre-
sent other stigmata of degeneracy as well. In other words, I
reasoned that I should have no difficulty in finding concentration,
so to speak, of stigmata of degeneracy in subjects said to be degen-
erate because of certain forms of their ears. I therefore chose
normal and insane subjects (Velikorussy) who had anomalies of

THE DEGENERATE EAR— Dr. Vorobieff. ji

their teeth as regards development and implantation. I then
expected to find every subject with such defective teeth to also
present the so-called ' 'degenerate" forms of the ears. Among
the subjects thus chosen I could find no difference whatsoever
between the shapes of the ears of normal and insane respective-
ly— as compared with ears of subjects with normal teeth. For
want of space I do not present the detailed statistical data relating
to this side of the question.

From all that has been said here it does not follow that the ear
never presents any characteristics of degeneracy. I mentioned
above the standing out ear and its relation to degeneracy. Ap-
parently there exist some more characteristic traits frequently
met with among the insane pointing towards degeneracy, but
those traits have not been clearly described in psychiatry. As I
have already remarked, the majority of the traits designated as
stigmata of degeneracy are simply of embryonic origin. Along-
side with these traits, however, there exist also true anomalies, —
atypical traits, that are difficult to accurately describe. Some of
these are fissures and colobomata of the lobule and other parts of
the ear, abnormal formations on the ear in the form of tubercles,
warts, etc., often representing rudimentary additional outer ears.
In some rare cases, the entire ear shell is absent, being replaced
by some undifferentiated warts. To this class of anomalies also
belong those in which only specific parts of the ear are thus dis-
figured. Such are — flattening, indentations under various angles
of the borders of the helix and anti-helix, as if cut out, etc. Such
traits are distinctly monstrous malformations, although they do
not impress us as such at first sight. In my personal studies of
normal Russians (Velikorussy) I have only 9% of my cases with
such malformations. This percentage is small, and it is possible
that a study of the population at large would show that such sub-
jects are more or less distinctly degenerate psychically. Among
the insane Russians (Velikorussy), however, the number of truly
atypical cases is much higher — 2.0%. I do not say that every
degenerate subject has such anatomical anomalies of his ears.
The reverse conclusion, however, I readily admit : all or almost
all bearers of that kind of anomalies are subject more or less
degenerate.

In conclusion I present below statistical tables showing the
results of my personal studies of ears among normal and insane
Russians (Velikorussy).

1. I wish to point out that the method was uniform for all the
cases studied and I personally conducted the studies. Schwalbe's
schema was used. As is known, he divides and subdivides the

j2 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

various groups and forms so that one is enabled to make the finest
possible classification.

2. I first studied insane and degenerate (Velikorussy), so
that the data relating to them were obtained before I had obtained
any definite knowledge of the structure of the ears of normal
Russians (Velikorussy). This was an additional guarantee
against the commission of subjective errors.

3. The normal and insane Russians (Velikorussy) were chosen
from among similar groups by birth and social position. The
subjects of all the groups were peasants from the central Depart-
ment of Velikorussia, and had been in those regions for years.
Besides, all the subjects chosen were born and brought up in the
country at least until they were 16 to 18 years of age and their
occupation was agriculture. normal. insane.
Darwin's ear, group 1 0.3% i-5^°

" group II 9.8% 12.0%

" group III 34% 4.5%

" group IV 5.5% 9.0%

" group V 47-4% 35-°^°

" group VI 33.5% 38.0%

Helix a, its upper part.

Group I 0.0% 2.0%

Group II 23.1% 12.0%

Group III 76.9% 86.0%

Helix b, its lower part.

Group I 7.4% 13.0%

Group II 40-6% 35.5%

Group III 52-0% 5i-5^

Anti-helix. Group I 11.3% 8.5%

Group II 58.5% \ 67.0%

Group III (Wildermuth's

ear) 30.1% 23.0%

Lobule: group I, gradual junction

with cheek at an acute

angle 13.7% , 20.5%

group II, simple adherence. 21.7% 20.0%
group III, lobule somewhat

distant from face 26.1% 27.5%

group IV, completely free . . 38.4% 30.0%
Standing out ear :

group I, flattened against

the head . . 7-39% 9-°^

group II, average position. 82.1% 60.5%

group III, standing out ear. 10.4% 35-°%

THE DEGENERATE EAR— Dr. Vorobieff. 73

NORMAL. INSANE.

Atypical conformation (coloboma, in-
dentations, partial impairment of

form of individual parts, warts, etc.) 9.0% 22.0%

I shall conclude as follows :

1. The majority of statistical data regarding the "degenerate"
ear are founded on numerous and major errors of method; for
this reason the findings of various authors differ from and are
opposite to one another, — all being equally unreliable.

2. The measurements of the ears do not differ materially in
normal and insane subjects respectively. It may be added, never-
theless, that in the insane and degenerate the general tonicity
of the ear shell is relaxed, giving the ear somewhat exaggerated
dimensions in length and in breadth.

3. The embryonic types of the ear are markedly prevalent
among normal subjects. Among the insane and degenerate these
forms prevail either to the same extent as among normal subjects
or, if the proportion is somewhat higher, the difference is too
small to be of any significance.

4. The standing out ear, on the contrary, is of significant
meaning: although it may be found among normal subjects now
and then, it is met with to a marked degree among the degenerate.
It should be supposed, however, that in this case the structure of
the ear alone is responsible for its characteristics: the structure
of the skull may also contribute to its peculiar attitude.

5. There are peculiarities of the ear structure that are seldom
found among normal subjects. These peculiarities have hardly
been pointed out by other authors, if at all. These peculiarities
are in no way characteristic and cannot be generalized as to their
configuration. In a word, — they are true anomalies.

REFERENCES.

1. Morel. Traite des degenerescences, etc., Paris, 1857.
Morel. Des caracteres de l'heredite dans les maladies

nerveuses, Arch, general de medecine, 1859.

2. Stahl Fr.; Einige Skizzen ueber Missgestaltungen des
auesseren Ohres, Allg. Zeitschr. f. Psych,, Bd. 16, 1859.

3. Legrand du Saule. La folie hereditaire, 1876, Paris.

4. Wildermuth. Wuertemberger Correspondenzblatt, No.
40, 1886.

5. Lomrroso. L'uomo delinquents, Turin, 1884.

6. Gradenigo. Ueber die Form Anomalien der Ohrmuskel,
Arch. f. Ohrenheilk, Bd. 32, 33.

7. Gradenigo. Die Formentwickelung der Ohrmuskel tnit

74 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

Ruecksicht auf die Morphologie and Teratologic der selben, Cen-
tralb. f. med. Wochenschr., 1888, and other works.

8. Binder. Das Morel'sche Ohr, Arch. f. Psych., Bd. XX,
1889.

9. Fere and Seglas- Contribution a l'etude de plusieurs
varietes morphologiques du pavilion de l'oreille humaine, Revue
d' anthropologic, 1886.

10. Roher. Ueber Bildungsanomalien der Ohrmuschel, Wien.
Med. Wochenschr., No. 1, 1894.

11. Roher. 58th and 59th Congress of Naturalists, 1885, 1886.

12. Lannois. De l'oreille au point de vue anthropologique et
medico-legal, Arch. d: 'anthropologic criminelle, July, 1887.

13. Lannois. Pavilion de l'oreille chez le sujet sain, Arch,
d' anthropologic criminelle, July, 1892.

14. Topinard. Element d'anthropologie generale, 1885, Paris.

15. Schwalbe. Beitrag zur Anthropologic des Ohres, Fest-
schr. f. R. Virchow, Bd. I, 1891.

16. Karutz. Ein Beitrag zur Anthropologic des Ohres, Arch,
f. Anthropologic, Bd. 26, 1900.

17. Karutz. Studien ueber die Form des Ohres, Zeitschr. f.
Ohrenhcilk., Bd. 30 and following.

18. V. Vorobieff. The outer ear of man, Report, anthropo-
logical section, Society of Naturalists, etc., Vol. XX, 1901, Moscow.

19. Frigero. L'oreille externe, Arch, d'anthrop. crimin., 1888.

20. Gradenigo. Ricerche antropologiche sul padiglione deH'
orecchio, Gior. delV Academia di Medicina di Torino, 1889-90 and
other works.

21. Julia. De l'oreille au point de vue amthropologique et
medico- legal, 1889.

22. Ganter. Der Kocrperliche Befunde bei 345 Geisteskran-
ken, Algem. Zeitschr. f. Psych., Bd. 55, 1899.

23. N^ecke. Die sogennante aussern Degenerationszeichen
bei d. progr. Paralyse d. Maenner, Allg. Zeitschr. f. Psych., Bd.
55, 1899.

24. Willhelm. Materiaux pour scrvir a l'etude anthropolo-
gique du pavilion de l'oreille, cited by Schwalbe.

25. Schwalbe. Das Darwin'sche Spitzohr beim Menschen
Embryo, Anatom. Anzeig, IV, 1889.

26. Schwalbe. Inwiefern ist die menschliche Ohrmuschel ein
rudimentaeres Organ ? Arch. f.Anat. u. Physiol., Anat.,Abth., 1889.

2J. Schwalbe. Ueber die fergleichende Anatomic und Ent-
wickelungsgeschichte des Ohrknarpels, Deut. med. Wochenschr.,
No. 15, 1889.

28. Schwalbe. Zur Methodik statisticher Untersuchungen
ueber die Ohrformen, etc., Arch. f. Psych., Bd. 27.

29. Schwalbe. Lehrbuch f. Anatomie. Das auessere Ohr, 1897.

30. Schaeffer. Ueber die foetale Ohrentwickelung, etc.,
Arch. f. Anthropologic, Bd. 21, 1892-93.

ELECTROCUTION. AN EXPERIMENTAL STUDY
WITH AN ELECTRIC CURRENT OF LOW
TENSION. ILLUSTRATED WITH CAR-
DIOGRAPHY AND RESPI-
RATORY TRACINGS.

WITH SOME CRITICAL REMARKS ON THE PRESENT
METHOD OF THE OFFICIAL ELECTROCUTION.

A Preliminary Communication.

By Louise G. Robinovitch, B. es L., M. D., Member New York
Academy of Medicine; Member, American Medical Associa-
tion; Foreign Associate Member, Medico-Psychological So-
ciety, Paris.

In this note is embodied one of a series of experiments pre-
sented at the V-th International Congress of Psychology, held in
Rome, Italy, April 26-30, 1905. I wish to remark at the outset
that the experimental electrocution of which I shall speak here is
simply a detail of a study in which I am now engaged. I do> not
wish to convey the impression, however, that I endorse the idea
of electrocution as applied to man. I disapprove of all forms of
capital punishment. Those who are familiar with my views on
the evolution of criminality and my suggestions as to its eradica-
tion (1) are also familiar with my views regarding capital pun-
ishment : capital crime never can and never will be eradicated by
the infliction of capital punishment. Leaving this vexed question
to itself for the present, however, I shall give here an exposition
of the method I have employed in experimental electrocution.
This method may serve to show how crude and horrible is the
method of electrocution now applied in capital punishment in
the State of New York.

In my experiment I have used the Leduc current. Professor
Sthephane Leduc, of Nantes, France, was the first to show its
use and application in various ways. In my work I have used
different interrupters, and shall make comments on their respec-
tive merits and demerits in due time. In the present experiment

76 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

I used Professor Leduc's interrupter as constructed by a French
firm. The interrupted current is so regulated that it passes one-
tenth of the entire time.

The animal, a rabbit, is fixed to a board and properly strapped,
so that tracings may be taken without the interference that would
otherwise be caused by the convulsive movements caused by the
current.

The appliances for recording the cardiac beats and respirations
are applied to the chest in the proper places and the cardiograph
is set in motion. The cardiograph I have used is a special instru-
ment invented by Professor Rouxeau, of Nantes, for the especial
purpose of obtaining tracings during any number of hours de-
sired. Such tracings are especially valuable for recording the
cardiac and respiratory curves during electric sleep, that is readily
induced by the current here mentioned. In a future issue of this
Journal I hope to describe the method of inducing electric sleep
and show tracings taken uninterruptedly during electric sleep that
lasted some 3^2 hours (*). For the present, I wish to mention
the important points concerning experimental electrocution by
means of the Leduc current.

1. The cathode should be applied to the forehead and the
anode to the abdomen.

2. For a good sized rabbit, 14 volts constitute a lethal current.
This number of volts is not absolute, — varying with the animal —
not with its size.

3. From the series of experiments, of which the one presented
here is a part, it is correct to conclude that the animal loses con-
sciousness the instant the circuit is closed.

4. Consciousness is lost when only five volts, more or less, are
turned on.

5. In experiments on "electric sleep" this number of volts,
applied as described above, induces a condition that has every
appearance of sleep. During the continuance of this condition
sensibility is abolished and voluntary muscular motility is com-
pletely abolished.

6. In rabbits it is necessary to apply, for the purpose of electro-
cution, approximately 2 J/2 times as many volts as are necessary to
induce "electric sleep. "

7. Consciousness is lost when a lethal current is applied as indi-
cated above.

8. There is neither edema nor blistering of the parts corre-

* Dr. Louise G. Robinovitch. Electric sleep demonstrated and respira-
tory and cardiac tracings during that sleep exhibited at the V-th Inter-
national Congress of Psychology, held in Rome, Italy, April 26-30, 1905.

ELECTROCUTION. AN EXPERIMENTAL STUDY.— Dr. Robinovitch. 77

sponding to the places where the electrodes had been applied. In
the instance of capital punishment by the present method of
electrocution, on the contrary, there are both edema and blister-
ing of those parts (2).

9. We do not know whether the subjects who suffer the pen-
alty of death by electrocution, inflicted according to the method
in vogue, retain consciousness during any period of time during
the application of the lethal current (*).

10. Leaving aside the sentimental as well as the scientific side
of the question of capital punishment, it seems to be our duty, on
purely humane ground, to do away with any unnecessary physical
suffering, of subjects paying the death penalty, because of the
method of infliction of electrocution.

11. Pending the abolition of capital punishment in this coun-
try in general and of electrocution in the State of New York in
particular, humane reasoning dictates our doing away with suffer-
ing of the condemned so far as it is in our power so to do. The
first point to be attained is to ensure suspension of consciousness ;
the second is to make certain cardiac and respiratory paralysis.
These conditions are readily realized in their desired order b}^
the use of the current applied in this experiment. The entire
process is obtained with a low voltage. In man, from 150 to 200
volts would probably suffice. With this number of volts and
the mode of use and application of the current here indicated,
there is obtained not only loss of consciousness, preceding cardiac
and respiratory inhibition, but there is also avoided blistering,
edema and burning of the parts corresponding to the places where
the electrodes are applied.

12. In one of the records of electrocution in the State of New
York (3) it appears that 1800 volts were used. In the case of
Czolgosz, "1800 volts were maintained first for seven seconds,
then reduced to 300 volts for twenty-three seconds, increased to
1800 volts for four seconds and again reduced to 300 volts for
twenty-three seconds, the whole having lasted one minute."

13. In the published records of electrocutions it is evident that
no significance is attached to> the importance of the specific place
on the head where the electrode should be applied. Nor is it
indicated whether the anode or cathode was applied at the head.
In Czolgosz's case it may be inferred that one of the electrodes
had been applied at the occiput: "Corresponding to the attach-
ment of the leg-electrode there was a superficial blistering, with
some desquamation of the epidermis and some edema. At the

* I shall make some further remarks on this point in the notes ap-
pended to this paper.

78 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

site of application of the bead-electrode there were only a few
signs of vesication limited to the occiput" (4). In one of the cases
published by Dr. MacDonald, the electrodes had been applied
to the hands (*).

14. Putting aside the question of sentiment, it seems common
humaneness to abandon the use of high voltages and the hap-
hazard application of electrodes that leaves us in the dark regard-
ing the possible agonizing sufferings of the subjects undergoing
electrocution, since we do not know whether the general sensi-
bility and consciousness are instantly abolished under the present
crude methods of application. With the method of application
used in this experiment, we have laboratory proof that sensibility
and consciousness are both lost with a voltage amounting to
only 40% of that necessary for lethal purposes. Respiratory ana
cardiac inhibition are then obtained synchronously with the loss
of consciousness and of general sensibility. There is neither
edema, blistering, nor burning of the tissues as consequences of
the application of the current. As has already been remarked, in
man it would probably be necessary to use between 150 and 200
volts for lethal purposes.

EXPLANATION OF THE TRACINGS.

The uppermost tracings presented herewith represent the res-
piratory curves ; the lower represent the cardiac beats that are
somewhat masked by the respiratory movements ; the third and
lowest tracings indicate the time: one double oscillation equals
2 seconds.

The closing of the circuit (12 volts, 2 and 2-3 milliamperes
and passage of the current one-tenth of the time) causes, with
a deep inspiratory movement, complete respiratory inhibition,
while the cardiac beats persist — although they are quite feeble.
It appears that as the current is continued, the amplitude of the
cardiac beats augments ; the character of the tracings is accen-
tuated with every renewal of the experiment.

In my experiment the current was applied the first time for a
period of ten seconds ; the second time, for twenty-seven seconds,
and the third time for twenty-three seconds. The periods are
separated by pauses of several minutes (**). The fourth renewal
of inhibition was caused with 14 volts, 3 milliamperes, same num-
ber of interruptions, and was maintained during a period of 32
seconds — causing death.

On opening the circuit, a violent and profound expiratory

* See extracts in the appended notes.

** Portions only of the tracings are published with this paper.

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ELECTROCUTION. AN EXPERIMENTAL STUDY.— Dr. Robinovitch.

movement occurred, as usual, but normal respiration did not re-
turn. The cardiac beats were immediately modified in a charac-
teristic manner, but the normal cardiac movements did not re-
appear, neither did the respiratory movements.

An animal thus electrocuted may sometimes be resuscitated by
the application of rhythmic excitations with the same current
that had caused death. This mode of resuscitation was tried in
this experiment. The duration of the current at each rhythmic
period is seen from the tracings. In this case resuscitation was
impossible : the lethal current had been applied too long a time, —
32 seconds.

I am deeply indebted to Professor Leduc and Professor Roux-
eau for their generous assistance in this work. Their presence
during the experiments and the taking of the tracings was a great
help, and I take this opportunity to again express to both of them
my sinoerest thanks for their kindness.

REFERENCES.

1. Dr. Louise G. Robinovitch. On the Duty of the State in the
Matter of the Prevention of the Birth of Crime and of its Pro-
pagation. The Journal of Mental Pathology, Vol. I, No. 3, 1901.

2. Drs. Carlos F. MacDonald and Edward Anthony Spitzka.
The Trial, Execution, Autopsy and Mental Status of Leon F.
Czolgosz. The Journal of Mental Pathology, Vol. I, Nos. 4-5.

3. L. c, p. 185.

4. L. c, p. 195.

REMARKS.

As to the method of electrocution applied in the infliction of
the death penalty in the State of New York, — in the appended
notes the reader can pick out for himself the various paragraphs
showing the following points of interest :

1. No rule is followed regarding the application of the re-
spective electrodes.

2. We are supposed to take on faith the statement that "life
was extinct," although muscular contractions and radial pulsa-
tions were evident after one or more applications of the current.
Yet in our experiments it is found that not only is. life not extinct
when cardiac beats continue to manifest themselves, but even
when life seems to all appearances extinct — when neither respira-
tion nor cardiac beats are being registered by the cardiograph —
the animal may be resuscitated by rhythmic electric excitations
with the same current that had caused death. The statements re-
garding the extinction of life, while cardiac beats, radial pulsa-

go THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

tion and respiration still persisted, seem, therefore, to be arbitrary
for the reasons that follow :

(a) Because our laboratory experiments do not support the
opinion that life is extinct when muscular movements, radial
pulsations or heart-beats are visible and perceptible.

(b) Because it is not stated that resuscitation had been tried
in any one of the cases of electrocution.

In laboratory experiments resuscitation may be obtained, if
the lethal current is not continued too long a time, even when
respiration and cardiac beats have completely ceased. The pro-
cedure is indicated in the tracings accompanying my paper.

The reading of some paragraphs on page 83 gives one the im-
pression that the method by which electrocution is enacted in the
State of New York can hardly be called scientific. Indeed we
are told that "the number of contacts varied from two to four
and the aggregate length of the contacts in each case varied from
forty-five to eighty-seven seconds," respiration, cardiac beats and
radial pulsations being observed after the 1st, 2d, 3d, and 4th
closure.

Yet, under such prolonged and repeated contacts in all the*
cases, the following conditions prevailed :

"In Kemmler's case there were chest movements, and possibly
heart beats, after the first contact (seventeen seconds) ; in
Slocum's, chest movements and radial pulsation after the first
contact (twenty-seven seconds) ; in Smiler's, no movements of
chest, but radial pulsation after three contacts (ten seconds each) ;
in Jugigo's, a slight fluttering of radial pulse when final contact
was broken, which rapidly ceased."

We are informed that "In all the cases except Kemmler's and
McElvaine's contact was broken for the purpose of wetting the
electrodes."

This did not prevent vesication to take place, as is indicated
in the extracted paragraphs.

"The electromotive pressure varied from 1458 to 1,716 volts,
while the ammeter showed a variation in current of from 2 to 7
amperes."

When such high voltage gives results as horrible as noted here,
and the current has to be turned on from two to four times before
life is extinguished, it seems to be high time to acknowledge
frankly that the method used in inflicting the death penalty by
electricity is faulty and unscientific.

I have pointed out in what respect the method is unscientific.
Of course, I have been comparing two electric currents of en-
tirely different qualities. But, if the common induction current

ELECTROCUTION. AN EXPERIMENTAL STUDY.— Dr. Robinovitch. 8l

gives such horrible results when high voltage is used, is it not
time to abandon its use and to replace it by one giving more ac-
ceptable results? Besides, the results obtained with the current
advocated here may be prearranged almost to mathematical exact-
ness— as compared with the crude and horrifying surprises that
have thus far been obtained in the recorded electrocutions.

Electrocution is considered by some as being a method of ex-
ecution preferable to hanging, because electrocution is the less
horrifying and degrading of the two (*). This is, no doubt, quite
true — in so far as the advocates' knowledge of the methods of
electrocution is concerned. When the method now in use in the
State of New York is compared, however, with that described
herein, the striking horribleness of the electrocution in use here
becomes appalling.

EXTRACTS.**

Touching on the salient points in regard to methods of electro-
cution.

"... and from which was suspended the head electrode, so as to
rest on the vertex, or top of the head" (p. 5).

"The spinal or body electrode was attached to the lower part of the
back of the chair and projected forward horizontally on a level with the
hollow of the sacrum" (p. 5).

"Before Kemmler was brought into the room the warden asked the
physicians how long the contact should be maintained; the writer re-
plied, 'Twenty seconds/ but subsequently assented to ten seconds, in
deference to the opinion of another that a considerably less period of
time would suffice — an opinion which doubtless would have been sustained
had the electro-motive pressure been sufficiently great.

"Unfortunately, in this instance, the voltmeter, ammeter, switch-
board, etc., were not located in the execution room; hence none of the
official witnesses could know precisely how much the electromotive pres-
sure and current strength were at the time of making and during the
continuance of the first contact. Nor has the voltage or amperage in
this instance, to the writer's knowledge, ever been officially determined,"
etc., the conclusion being that "no human being could survive the passage
through his body of an alternating current of more than 1,500 volts for
a period of even twenty seconds, the contact being perfect" (p. 6).

"The instant the contact was made the body was thrown into a state
of extreme rigidity, every fiber of the entire muscular system being ap-
parently in a marked condition of tonic spasm. Synchronously with the
onset of rigidity, body sensation, motion, and consciousness were sus-
pended, and remained so while electrical contact was maintained. At

* Dr. Edmund W. Holmes, Anatomy of Hanging. The Pennsylvania
Medical Journal, July, 1901, p. 737.

** Extracts from paper by Dr. Carlos F. MacDonald, The Infliction of
the Death Penalty by Means of Electricity. New York Medical Journal,
May 7 and 14, 1892. The numbers of pages refer to the reprint of the
paper.

g2 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

the end of seventeen seconds Kemmler was pronounced dead, none of
the witnesses dissenting, and the warden signaled to have the contact
broken, which was immediately done.

"For obvious reasons, the only means of determining the question of
death while the body was in circuit was by ocular demonstration; so that
it cannot be positively asserted that the heart's action entirely ceased
with the onset of unconsciousness, though most of the medical witnesses
present thought that it did.

"When the electrical contact was broken the condition of rigidity
noted above was instantly succeeded by one of complete muscular relaxa-
tion. At the same time superficial discoloration resembling commencing
capillary post-mortem changes were observed on the exposed portions
of the face. The body remained limp and motionless for approximately
half a minute, when there occurred a series of slight spasmodic move-
ments of the chest, accompanied by the expulsion of a small amount of
mucus from the mouth. There were no evidences of return of conscious-
ness or of sensory function; but, in view of the possibility that life was
not wholly extinct, beyond resuscitation, and in order to take no risk of
such a contingency, the current was ordered to be reapplied, which was
done within about two minutes from the time the first contact was broken.
The sudden muscular rigidity noted on the first closure of the circuit
was again observed and continued until the contact was again broken.
The second closure of the circuit was inadvertently maintained for about
seventy seconds, when a small volume of vapor, and subsequently of
smoke, was seen to issue from the point of application of the spinal elec-
trode, due, as was subsequently found, to scorching of the edge of the
sponge with which the electrode was faced, and from which the moisture
had been evaporated by prolonged electrical contact. The odor of the
burning sponge was faintly perceptible in the room. There was also
some desiccation of the already dead body immediately underneath the
electrodes, especially under the lower one," etc. (p. 8).

"In the excitement and confusion of the moment, occasioned by the
belief on the part of some that death was not complete, the second appli-
cation of the current in Kemmler's case was maintained too long — nearly
a minute and a half. If there was a spark of unconscious vitality remain-
ing in the prisoner's body after the first contact was broken — there cer-
tainly was no conscious life — it was absolutely extinguished the instant
the second and last contact was made. That the man was dead, how-
ever, comparatively long before the burning of the sponge and desicca-
tion of the tissue occurred, there is no reason to doubt" (p. 9).

. . . "also that less than four minutes elapsed between the making
of the first contact and the breaking of the last one when Kemmler was
absolutely dead," etc. (p. 10).

On page n the author says that he had suggested application
of the head electrode to the forehead, but it is not specified which
of the electrodes should so be applied.

"The movements referred to were regarded by most of the medical
witnesses present, including the writer, as similar in character to those
which have occasionally been observed for a short time in animals ex-
perimentally killed by electricity, when this contact was too brief or the
current strength insufficient, the animal dying, however, in a short time
without regaining consciousness — movements which may prdperly be

ELECTROCUTION. AN EXPERIMENTAL STUDY.— Dr. Robinovitch. 83

regarded as involuntary or reflex in character, following the too early
interruption of the current, and in no sense a resumption of respiratory
function, however much they may appear to be so to superficial observers
or to those not familiar with the phenomena referred to, as observed in
experiments on lower animals" (p. 9).

"In each of the five cases following the Kemmler case — namely, Slo-
cum, Smiler, Wood and Jugigo, executed at Sing Sing Prison, July 7,
1891, and Loppy at the same place, December 7, 1891 — one electrode was
so applied as to cover the forehead and temples, and the other, a larger
one, the calf of the right leg," etc. (p. 11).

"The following summary of these executions, except as relates
to Kemmler, is taken from the official reports made to the warden
of the prison, the Hon. W. R. Brown, by Dr. S. B. Ward, of
Albany, N. Y., and the writer, who appeared as medical advisers
for the State :

It is said in part,

"The electromotive pressure varied from 1,458 to 1,716 volts, while
the ammeter showed a variation in current of from 2 to 7 amperes"
(p. 12).

"In Kemmler's case there were two contacts, through vertex and lower
end of spine, lasting seventeen and seventy seconds, respectively, the
last one being unnecessarily prolonged; in Slocum's case, two contacts —
twenty-seven and twenty-six seconds; in Smiler's case, four contacts,
three of ten seconds each and the fourth nineteen seconds; in Jugigo's,
three contacts of fifteen seconds each; in Loppy's case, four contacts of
fifteen, eleven, fifteen and a half and ten and a half seconds, respectively.
(In all of these five cases contact was through the head and leg.) And
in McElvaine's case, two contacts, the first one through the hands, last-
ing fifty seconds, and the last one through the head and leg, lasting!
thirty-six seconds" (p. 13).

"In Kemmler's case there were chest movements, and possibly heart
beats, after the first contact (seventeen seconds) ; in Slocum's, chest
movements and radial pulsation after the first contact (twenty-seven
seconds) ; in Smiler's, no movements of chest, but radial pulsation after
three contacts (ten seconds each) ; in Jugigo's, a slight fluttering of radial
pulse when final contact was broken, which rapidly ceased" (p. 13).

"In all the cases except Kemmler's and McElvaine's contact was
broken for the purpose of wetting the electrodes" (p. 13).

. . . "the number of contacts varied from two to four, and that the
aggregate length of the contacts in each case varied from forty-five to
eighty-seven seconds, at the end of which, if not before, in most instances,
both conscious and organic life were absolutely extinct" (p. 13).

"The mean activity developed in heat during the first application was
thus 4,080 watts, and in the second 10,500 watts, or about E. H. P., this
large expenditure of energy accounting for the considerable post-mortem
temperatures that are stated to have been observed" (p. 16).

Autopsies.

The first autopsy and microscopic examination was made by
Dr. E. C. Spitzka. The other autopsies and microscopic examina-
tions were made by Dr. Ira Van Gieson.

84 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 2.

Kemmler. — At the site corresponding to the dorsal electrode there
"was a burn, presenting four concentric zones," etc. ; "succeeding this was
a vesication, partial below and complete above, about an inch in diameter
above and one-third of an inch below."

"Then followed another zone, which was in its upper third a com-
plete eschar, black in appearance, and in its lower part showed desicca-
tion of a greenish-brown color. The last or inner zone showed a num-
ber of vesicles, chiefly peripheral, and below the center was a black
eschar, half an inch in its vertical and five-eighths of an inch in its
transverse diameter," etc. (p. 18).

"The scalp, on being removed, showed the outer aspect of the vertex
of the skull to be in a desiccated condition, corresponding with the site
of the electrode as previously noted, but a larger area, being four by
four inches, the zone of the scalp being only two and a half by three
inches, the long diameter being antero-posterior. On removal of the
skull-cap, the dura was normal in texture, somewhat dull in color, par-
ticularly over the area corresponding with the zone of contact. In the
pre-Rolandic region the meningeal vessels, measuring along the con-
vexity antero-posteriorly four inches on the left side and three on the
right, were filled with carbonized blood. On the internal aspect of the
calvarium the meningeal vessels in the dura and in their contents ap-
peared to be black and carbonized. The carbonized vessels were so
brittle that their ends were torn off with the calvarium and presented
a broken, crummy appearance. This carbonization was limited in an
abrupt manner," etc. "Over the left cerebral hemisphere, one-third of
an inch to the left of the median line, there was a deep carbonized spot
corresponding with the desiccated portion of the calvaria. The pia and
gyri were of a pale-buff color; the rest of the cerebral cortex was nor-
mal in appearance" (p. 19).

"Capillary hemorrhages were noted on the floor of the fourth ven-
tricle, also in the third ventricle and the anterior portion of the lateral
ventricle," etc. (p. 19).

"That the 'cooked' appearance of the muscular tissue of the back
beneath the site of the electrode, and the desiccation of the skull and
so-called 'carbonized' state of the blood-vessels on the internal aspect
of the calvaria over the area corresponding to the zone of contact, were
due to unduly prolonged second contact, together with failure to properly
moisten the electrodes, there can be no question," etc. (p. 21).

Jugigo.— "There were a few slight blisters on both temples, and both
cheeks and eyelids. There were raised whitish streaks on both sides of
the neck, just below the angle of the jaw" (p. 21).

Jugigo.— Floor of the fourth ventricle: "... on the left side there-
were a number of minute, radiating petechial spots from one to two
millimeters in diameter" (p. 23).

Smiler.— "Posterior surface of the body was of the same color, and
also showed the same blisters as in the case of Jugigo. The left leg
showed the same state of contraction" (p. 23).

Wood.— "Body presented same appearance as in preceding cases.
There was the same contraction of the leg and the same general appear-
ance as in the others. Same condition of epithelium of cornea" (p. 24).

"This tends to show how superlatively complete and far-reaching the
effects of the currents are in abolishing life, not only in the concrete
form, but also in the integral activities of the body which in other forms

ELECTROCUTION. AN EXPERIMENTAL STUDY.— Dr. Robinovitch.

of sudden and violent death is liable to persist for a time after life is
extinct. From observations at this execution, as well as at the subse-
quent examination of the body, the current appears at first not only to ex-
tinguish life in the ordinary sense of the word, so far as consciousness,
feeling and volition are concerned, with overwhelming suddenness, but
reaches beyond this and destroys the energies of the individual com-
ponent parts of the body so that they cannot be raised into activity by
artificial mechanical stimulation, as is usually the case in sadden violent
death" (p. 36).

The Journal of Mental Pathology.

Edited by Louise G. Roeinovitch, B. es L., M.D.

Vol. VII. J905- No. 2.

STATE PRESS, Publishers,
New York.

MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.

Address bulky mail matter to P. O. Box 1023, New York.

This Journal is published bi-monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.

Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope.

THE V-TH INTERNATIONAL CONGRESS OF
PSYCHOLOGY.

Held in Rome, Italy, April 26-30, 1905.
The congress was opened at the Campidoglio, in the hall
"Orazi e Curiazi," at 10 o'clock a. m. The Minister of Public
Instruction, Professor Leonardo Bianchi, greeted the congress
in the name of the king. Prof. Bianchi delivered a masterly
speech on the science of psychology and he was enthusiastically
applauded. The Government was also represented by the Min-
ister of Foreign Affairs; Hon. T. Tittone, the President of Con-
gress, Hon. Fortis, the Minister of Agriculture, Industry and
Commerce, Hon. Finocchiaro-Aprile and others. The congress
itself was represented by the presidents of the various sections
of the congress, Professors Luciani, Sergi, Sciamanna, Tam-
burini, Sante De Sanctis, etc., as well as by the foreign delegates.
The inaugural reception was as brilliant as it was impressive,
and the members of the congress carried away a delightful im-
pression of a warm welcome. The meetings were held at the
spacious Policlinico. Excellent system characterized the proceed-
ings. Indeed, it may be said that it is not common to find as good
order as that which prevailed at this congress. The entire mass
of work of the members of the congress was classified into four

EDITORIAL. 87

sections, in which sessions were held synchronously. While a
fixed schedule had been published and was ready for use at the
opening session, some changes had to be made daily.- A daily
bulletin gave the exact schedule of the day's work. Credit is due
to the Vice-Secretary-General, Prof. Sante De Sanctis, of Rome,
for this happy condition of affairs. Prof. De Sanctis is a born
organizer, and on this occasion he fully demonstrated his abilities
in this direction.

Many valuable papers were read and experimental work of in-
terest was also in evidence. Special rooms were fitted up for the
use of the experimenters.

The social part of the congress was a brilliant success. Rome
lent itself most graciously to the purposes of hospitality, and the
members of the congress fully appreciated the beauty of the
Eternal City.

April 26th, the Minister of Foreign Affairs gave a "Smoker."
April 27th, a visit was made to the Foro Romano under the direc-
tion of Prof. Boni. April 28th, the city of Rome entertained the
congress in the Capitolin Museum. April 29th, there was an en-
tertainment at the theater Costanzi. April 30, the Minister of
Public Instruction, Prof. Leonardo Bianchi, gave a tea for the
members of the congress in the Museum of the Villa Umberto I
{Villa Borghese). April 30th, there was a reunion at a banquet
at one of the leading hotels. Finally, May 1st, there was an ex-
cursion to the Villa Adriana and Tivoli.

Besides these entertainments, there were many luncheons, teas
and dinners, to emphasize the proverbial Roman hospitality.
Some of the most notable private teas and dinners were those
given by Professor and Signora Sciamanna and Professor and
Signora Mingazzini, at their respective residences.

The committee of the congress gave several impromptu lunches
at the Policlinic o, some 150 members attending at a time.

From all points of view, the congress was a great success.

The Proceedings of the Congress. — It is difficult to give any
detailed account of the proceedings of the congress at this time.
The papers were numerous and some of them were of the highest
scientific interest. A general and hasty sketch of the proceedings
will be given here and some of the papers will be abstracted in
this issue and in that to follow.

Professor Lombroso read a paper entitled "Sulle cause della
genialita Ateniese." Prof. Enrico Ferri presided, and the room
was filled to suffocation.

Prof. William James read a paper dealing with consciousness

38 OBITUARY NOTES.

and perception. He had a large audience. He is highly esteemed
by the Italians. Dr. Claparede made some pointed critical re-
marks on Prof. James's notions on perception, etc.

Prof. Flechsig read a paper on the "Physiology of the Brain and
the Theory of Volition."

Professor Sciamanna's work excited considerable interest. The
subject of his work was the "Psychic Function of the Brain."

Prof. Flournoy, of Geneva, was elected President of the Sixth
International Congress of Psychology, which will be held in Gen-
eva, Switzerland.

THE CHAIR OF PSYCHIATRY, ROME.

Professor Sante De Sanctis has been appointed to fill
temporarily the Chair of Psychiatry at the University of Rome.
The vacancy was caused by the death of Professor Sciamanna.

Professor De Sanctis is one of the most distinguished young
psychologists in Italy. He is Professor of psychology at the Uni-
versity of Rome, Italy.

Princess Louise. — The report on the mental condition of
Princess Louise has been delayed on account of the death of Dr.
Gamier. Drs. Magnan and Gamier were to have made the re-
port. Dr. Dubuisson has been appointed to fill the vacancy caused
by Dr. Garnier's death. It is thought that the report regarding
the Princess's mental alienation will remain negative.

Henry E. Allison, M. D. — Dr. Allison died November 12,
1904. The last fifteen years of his life had been devoted to the care
of that most difficult class, — the criminal insane. He took an active
part in the planning and construction of the Matteawan State
Hospital, of which he was made Superintendent at the time of
its opening. This position, which he filled with great ability and
honor, he held until the time of his death. He was also a
copious contributor of valuable papers on psychiatric subjects.
His manliness and professional merit endeared him to those who
knew him. He was only fifty-four years old at the time of his
death.

Professor Ezio Sciamanna. — The news of the death of Pro-
fessor Ezio Sciamanna came as a sudden shock. Prof. Sciamanna
died in the early morning of May 14th, 1905. He had been suf-
fering for some time from an affection of the liver, but did not
allow his indisposition to interfere with his daily occupations,
keeping up his work almost to the last day of his life. Early in
the morning of May 14th, he was suddenly awakened by a spell
of hepatic colic and died before his physician arrived.

OBITUARY NOTES. 89

Professor Sciamanna was born in Albano, in 1850, and grad-
uated in medicine from the University of Rome in 1876. He then
studied with Magnan and Charcot, in France and with Meynert,
in Germany and visited the principal neurological centres in Lon-
don, Berlin and Vienna. In 1881, he became assistant Professor
of neurology at the University of Rome, and four years later
was appointed Professor of clinical psychiatry at the same Uni-
versity. Besides being an excellent clinician, Professor Scia-
manna contributed valuable material to the experimental study
of cerebral function. He was one of the great Italian workers
in neurology and commanded the respect and devotion of his
numerous pupils and colleagues. He was only fifty-five years
old at the time of his death.

Dr. Paul Garnier. — Dr. Paul Gamier died suddenly March
1 8th, 1905. For many years he had been Chief Physician of the
Iniirmerie du Depot, Paris, where some twenty thousand insane
are examined yearly before they are sent to the Admission
Bureau, at the Ste-Anne Asylum. His important position, his fine
qualities as a clinical psychiatrist and his brilliant career as an
expert psychiatrist at the Tribunals made him one of the best-
known men in psychiatric circles. His works on criminality in
general, on juvenile criminality in particular and on alcoholism,
are familiar to all. His excellent work in the matter of wresting
from the hands of the law hundreds of subjects who were looked
upon by the law as criminals, but who in reality were mentally
unsound, was as striking as it was scientific. He was one of the
most enthusiastic pupils of Magnan's School, and had daily oc-
casions to force on the law the acceptance of the truth that many
delinquents and criminals were simply mentally unsound and
irresponsible before the law. The vast experience in and knowl-
edge of psychiatry he had accumulated during his active and en-
thusiastic work in the Infermerie de Depot was to have been
crystallized by him into a colossal work — when death suddenly
stilled his spirit. He was but fifty-six years old when he died.

Sir John Sibbald. — Sir John Sibbald died at the age of seventy-
two years, in Edinburgh, Scotland, April 20, 1905. Almost his
entire professional life had been devoted to the study of
psychiatry and the amelioration of the conditions of the insane.
As Commissioner in Lunacy he had inaugurated a series of im-
portant reforms in the hospitals for the insane in Scotland. His
frequent visits to France, Germany, Holland and other countries
for the purpose of personally studying the newest system of car-
ing for the insane are familiar to the profession. He did not

po CONGRESS OF PSYCHOLOGY.

make these studies in a perfunctory manner: when he wished to
learn the true value of certain innovations, such as the colonization
of the insane and family care for the same, he went to live in their
colonies and watched the development of the innovation. The
vast improvements in the Scotch hospitals for the insane are due
to his enthusiastic efforts. For some time he had been suffering
from a throat affection, but resignedly accepted the fact that it
was incurable.

PAPERS READ AT THE V-TH INTERNATIONAL
CONGRESS OF PSYCHOLOGY.

HELD IN ROME, ITALY, APRIL 26-3O, I905.

Cerebral Physiology and "Theory of Volition. — Prof. Paul
Flechsig: the theory of cerebral localization is once more em-
phasized. The prefrontal lobe is intimately connected with the
function of volition. Pathology has fully demonstrated that par-
ticular function is proper to every individual cerebral centre.
Cerebral embryology also demonstrates the theory of specific
cerebral localization. The motor cells are first to appear. The
motor zones of the extremities form the nucleus, so to speak, and
the other cortical zones group themselves around the motor zone.
First in order among these zones is that of ideation and the last
is that of association — the frontal lobe being the last to develop.
There is a characteristic proportionate difference between the
association centres in both sexes.

Psychic Function and the Cerebral Cortex Prof. Scia-

manna: clinicians and physiologists are again discussing the
theory as to whether the anterior lobes are the seats of in-
telligence. The association areas of Flechsig may not be con-
sidered as true ideation centres or centres of higher dignity. In
1894, Bianchi declared that the frontal lobes in monkeys were the
seats of the highest psychic function, and in 1900, he virtually
confirmed his previous opinion. Prof. Sciamanna's experiments
on monkeys do not convince him that the frontal lobes in these
animals are the seats of the high psychic functions as above. He
presented two monkeys, each of which had sustained ablation of
both frontal lobes at two different times. Their psychic mani-
festations, however, did not appear to him to have changed in
any way. He concluded, therefore, that ablation of a great part
of the frontal lobes in the monkeys presented did not cause any
change of their personality. At the very least, it may be said
that in monkeys the prefrontal lobes are not the seats of in-
tellectual function, properly speaking. It may be concluded that
intelligence is the resultant of the harmonious function of the

CONGRESS OF PSYCHOLOGY. 91

entire brain. The psychic disturbances that follow partial cerebral
lesions are due to solution of continuity in that harmony, but
it does not seem that more or less circumscribed cerebral areas
are the seats of intelligence.

Experimental Researches into the Anatomical Localization
in Dogs of the Delirious Symtom Due to Pellagrogenous
Toxic A gent &. — Dr. Carlo Ceni:

1. The pellagrogenous toxic agents of an excitant and con-
vulsant nature (aspergilliform and penicilliform) have a marked
elective action on the centres of the cerebral cortex. The same
toxic agents have no physiological effect either on the spinal
cord, medulla oblongata or the cerebellum.

2. These toxic agents act by irritation and excitation at the
same time, the action being diffuse and involving all the cortical
centres, both psycho-motor and psycho-sensorial, without show-
ing any special predilection for one or the other of these centres.

3. The toxic delirium here is localized in the entire cerebral
cortex, but especially in the occipital lobes. Ablation of these
lobes modifies considerably the manifestations of the delirium.
The results of these experiments preclude any supposition of a
sub-cortical seat of this toxic delirium.

4. The motor phenomena are limited to the motor region in
the strictest sense of the word.

Consciousness and Its Degrees. — Dr. Paul Sollier: con-
sciousness is not an autonomous, primordial or independent phe-
nomenon, or a phenomenon that can be isolated, that has an
action proper to itself, acting on the other psychological manifes-
tations. There is no consciousness outside of cerebral activity.
Consciousness is not even an epiphenomenon, as it exists even
when we do not see its manifestations: if every cerebral centre,
taken individually, contributes to the production of consciousness,
it may be said that there exists an indefinite fragmentation of
consciousness — according to the number of cerebral centres that
are brought into play; there are local consciousnesses as there
are local memories. In other words, the phenomena related to
the activity of every cortical centre may be accompanied by a more
or less marked degree of consciousness, according to the degree
of activity of the centre of action, etc.

"Electric Sleep." — Dr. Louise G. Robinovitch :

1. It is possible to produce cerebral inhibition or "electric
sleep" by means of an intermittent electric current of low tension.

2. From 1 to 10 volts are necessary to produce electric sleep
in a rabbit. For an adult man, from thirty-seven volts and up-
ward are needed.

92 CONGRESS OF PSYCHOLOGY.

3. The Leduc current produces a quiet sleep with abolition
of sensibility.

4. This sleep may be kept up for hours, the cardiac beats and
respiration remaining regular.

5. The cardiac and respiratory tracings, obtained with Pro-
fessor Rouxeaux's cardiograph, demonstrate these facts.

6. The sleep is instantly interrupted with the opening of the
circuit.

7. On awakening, the animal does not show any untoward
symptoms, ambulating in a usual manner, as if nothing unusual
had occurred to it.

8. Practical application of this mode of sleep may be useful
in neurology and in psychiatry.

9. During this sleep, it is possible to produce respiratory and
cardiac inhibition without killing the animal — if the inhibition
is not kept up too long. The animal can be resuscitated with an
electric current of a different potential.

10. This mode of cardiac inhibition and legal electrocution —
in countries where legal electrocution is in vogue — would be more
humane : with this current there is no burning of the flesh and no
exaggerated convulsions, the subject being unconscious during
the production of the cardiac inhibition.

Experimental Contribution to the Study of So-Called
Vita! Electro-Magnetism, by Means of the Galvanometer.
— Dr. Ed. Gast Desfossess : with a special galvanometer it was
possible to obtain indications of the existence in the human body
of vital electro-magnetic currents. Details concerning the vari-
ous precautions taken to avoid erroneous conclusions are indi-
cated, and theories regarding the nature of this current are con-
sidered.

Psychological Study of a Species of Myrmecidae Dr.

Henri Pieron : a certain species of ants was studied. The
sense of smell is the most powerful directing factor in their psy-
chic life. Ants of the same species and nest, when dipped in an
odorous substance and replaced in their former nests were
driven out by their associates, etc.

Experimental Researches into the Mentality of the
Lower Animals. — P. Hachet-Souplet : among other things,
it is stated that pigeon letter carriers and travelers of great dis-
tances are directed by the sense of vision.

Philosophy and Psychology. — Prof. Adechi Babatone:
philosophy prepares the path for science. Philosophy undergoes
involution with the growth of science that it creates and reaches
extinction when science is fully developed.

TRANSLATIONS AND ABSTRACTS OF CURRENT

LITERATURE.

The Question of the Relation of Syphilis and Gen-
eral Paralysis at the Academy of Medicine, Paris. —

Georges Vernet makes the report in the Annates Medico — Psy-
chologiques, No. I, 1905. There was a spirited discussion by the
leading psychiatrists, neurologists, pathologists and syphilograph-
ists of Paris, some arguing that syphilis was the cause of general
paralysis and others saying that it was not.

Fournier: general paralysis is unknown during the first two
years of syphilitic infection ; the earliest onset of general paraly-
sis during the course of syphilis is during the third year after in-
fection. General paralysis is not frequent of occurrence before
the end of the sixth year after infection. The most common
period of onset is between the sixth and twelfth years after the
infection, the maximum onsets taking place during the tenth
year. There is a progressive decrease in the onsets between the
thirteenth and twentieth years. After the twentieth year the on-
set of general paralysis is an exception.

In general paralysis syphilis is a constant cause ; most frequent-
ly syphilis is of a benign nature in its initial stage under those con-
ditions. The constant cause is insufficient treatment of the in-
fection (in four-fifths of the cases). In 15 out of 112 cases there
were some predisposing causes : 8 times, nervous overwork ; 5
times, alcoholism ; 3 times, marked venereal excesses. Twice only
was there well-marked nervous heredity.

The best safeguard for a syphilitic subject against general
paralysis consists in a methodic mercurial treatment continued
during a long period of time.

Prof. Raymond claimed a more important part for the role of
heredity than Prof. Fournier designated for it.

Prof. JofTroy repeated his well-known opinion on the subject
of the relation of syphilis and general paralysis : general paralysis
and syphilis are two distinct affections, each having its individual-
ity, and one does not give birth to the other — both being of dif-
ferent natures.

Prof. Cornil and Lancereau agreed with Prof. JofTroy.

The following were the critical remarks made by each orator
during the discussion:

Fournier: the extreme frequency of syphilis among the gen-
eral paralytics ; the large number of syphilitics who become gen-
eral paralytics ; the rarity of general paralysis among women, in
the country, among the ecclesiastics, the Quakers, etc. ; more fre-

94 RELATION OF SYPHILIS AND GENERAL PARALYSIS.

quent syphilitic histories among the general paralytics than
among other insane. Common association of general paralysis
with tabes ; heredo-syphilitic origin of juvenile general paralysis ;
familial, conjugal general paralysis.

Babinsky: the Argyll-Robertson sign is pathognomonic, or
almost so, of nervous syphilis, and the Argyll-Robertson sign is
common in general paralysis. Hence, fruitless results from syph-
ilitic inoculation of general paralytics.

Prof. Joffroy: the absence of differential characteristics as re-
gards symptoms, course, duration or anatomical lesions in general
paralysis whether it is of syphilitic nature or not. Different geo-
graphical distribution of general paralysis and syphilis respec-
tively. Rarity of tertiary lesions in general paralysis. Curable-
ness of the tertiary lesions, while the treatment remains powerless
so far as general paralysis of the same subject is concerned. Gen-
eral paralytics may contract syphilis and present the two affec-
tions at the same time, etc.

Among the figures quoted statistically, showing frequency of
syphilis in general paralysis there was between 7 and 94 per cent.,
according to the individual author. According to Prof. Ballet,
statistics alone may throw light on the subject, while according
to Lancereau, in medicine statistics almost necessarily lead to
erroneous conclusions. Prof. Raymond said that statistics had only
a relative value. Prof. Joffroy said that if severely scrutinized,
statistics may furnish useful information.

Meilhon, in 1891, drew attention to the fact that the natives
of Algeria were considerably subject to syphilis, while general
paralysis was of rare occurrence in that country. Prof. Joffroy
pointed out that similar conditions obtained in Bosnia, Herzego-
vina, Japan, Tunisia, Abyssinia, Birmania, Singapore, Java, Ko-
rea, Cochin China, on the coast of Malabar, etc., as reported by
various competent observers. This showed, he said, that syphilis
alone did not suffice to cause general paralysis.

Prof. Raymond quite agreed with the latter arguments, but
drew therefrom quite opposite conclusions : it is simply a question
of race ; in order to produce diffuse general meningo-encephalitis
syphilis must find a specially prepared soil caused by heredity.
In old Europe, where general paralysis is so common in degen-
erate families, syphilis finds the proper soil for the production of
general paralysis. ,

Prof. Cornil : there is a great difference between the lesions of
diffuse meningo-encephalitis and the specific new formation of
syphilis. Profs. Lancereau and Joffroy were of the same opinion.
Prof. Raymond called attention to the fact that with the perfec-

MALAY AND CRIMINAL RESPONSIBILITY OF INSANE MALAYS.

tion of method, one finds the co-existence of lesions proper to gen-
eral paralysis and to syphilis respectively — in the same brain. He
cited some personal cases and those of others. Prof. Cornil had
never observed such conditions. Prof. Fournier then said that it
was wrong to accord to syphilis only one characteristic form of
lesion. It is true that the lesions of diffuse meningo-encephalitis
differed from those caused by syphilis, but why not admit that
when syphilis causes general paralysis it causes lesions quite dif-
ferent from those produced when there is no general paralysis?
Barring arbitrary conclusions, it is not right to refuse to accept
the fact that the lesions of diffuse meningo-encephalitis are of
syphilitic nature — when clinical work teaches that general paraly-
sis is caused by syphilis.

Therapeutic considerations : M. Fournier admitted the complete
inefficacy of mercurial treatment in general paralysis. M. JofT-
roy: as antisyphilitic treatment has no effect on general paraly-
sis, then general paralysis is not of syphilitic nature. M. Four-
nier: when instituted at the earliest moment, specific treatment
is an excellen preventive measure. Prof. Jofrroy: mercurial
treatment is not a prophylactic against general paralysis.

General regret was felt that Dr. Magnan, so great an authority
on this subject, should have chosen to remain silent on this im-
portant occasion.

The Normal Malay and the Criminal Responsibility of In-
sane Malays.— Major Charles E. Woodruff: it is impossible
to apply to the Malay, Philippine Islands, medicolegal precedents
found proper in dealing with higher races. Acts that we abhor
are perfectly acceptable to the Malay people. Most of them have
been in contact with civilization only about from 50 to 150 years
and some of them have never been under the influence of civiliza-
tion. They are still savages, with a brain capacity of from 60 to
80 cubic inches. The normal American brains have from 20 to
25 cubic inches of brain more than the Malays. The Malays are
savages, although some of them have money, know how to speak
Spanish and wear fine clothes. In cruelty and savagery the Ma-
lays resemble very much the Indians : to murder people is an
acceptable occupation, and the Malays have an organized society
of professional murderers designated as Manduducot. The de-
mand for their services is great enough to keep the profession in
existence. In their native states they must murder to live, for
they are always encroaching on the hunting grounds of others;
and when they are subdued by a civilization that permits them to
over-populate the country far beyond the means of existence, it

g6 MALAY AND CRIMINAL RESPONSIBILITY OF INSANE MALAYS.

is really a great advantage to have many killed off. Like all sav-
ages, the Malays delight in cruel deeds and seem to take pleasure
in the suffering of others. There are shrieks of laughter in an
audience whenever a performing acrobat meets with a painful
accident. Cruelty to animals is a normal trait of these people.
Skinning animals alive and beating them to death are every day
incidents, the Malays claiming that the meat has a good flavor
when the beasts are killed in this fashion. Killing an adversary
in a quarrel is an ordinary event. In the details of their cruelty
the Malays resemble the North American Indian. When a Malay
becomes insane his cruelty is augmented: his homicidal trait is
brought out in an exaggerated form, and he generally kills as
many subjects as he can, attacking principally women, children
and the aged.

A study of the prison types shows that the assassins are
physically normal — presenting no stigmata of degeneracy. Lom-
broso has pointed out in Europe the normality of many assassins.
The ladrone — the common thieves and robbers, on the contrary,
present many stigmata of degeneracy and compare well, in this
respect, with Lombroso's "born criminal." Certain savage facial
characters, high cheek bones, voluminous jaws, etc., indicated by
Lombroso as characteristics of the born criminal among white
men, are normal traits of the Malays. Lombroso calls these traits
atavistic when found among the whites, but in this he may be
mistaken, for there is little or no evidence that our ancestors were
ever exactly like existing savages, who have been changed by
natural selection very much since they separated from the parent
genealogic stem. Indeed, no pure-blooded normal savages look
exactly like his type of the white "born criminal."

The ordinary thieves show evidences of degeneration. This is
to be expected, because their acts are so harmful and antisocial
as to be looked on as wrong by the mass of the people. Among
those who present stigmata of degeneracy — misshapen ears, etc.,
there are no deformities of the teeth; the latter are generally
perfect in form and in the contour of the arches, and generally
well preserved; the half breeds, or mestizos, particularly the
Spanish types, have excessively degenerate teeth and jaws. The
subjects described are all professional ladrone, real parasites upon
their kind. Ladronism has always been organized, supported and
led by the better classes of the people, — the rich and cultivated,
the mestizo, and it was precisely similar to the organized robbery
that existed in London up to 1815. The author remarks that it is
curious that nearly all the physically degenerate in the prison
were ladrones, while the murderers were normal.

STUDIES OF ENDEMIC CRETINISM.

The author points out the difficulty attending the administering
of American justice to a people of the morality described, to whom
murder, robbery, lying and perjury are normal acts. Neverthe-
less, the American Government is trying to hew its own path and
has succeeded in out-doing our own courts in some phases of the
administration of justice: if a murderer pleads insanity as an ex-
cuse for his act, it is possible to hold such a subject under rigid
medical surveillance for the rest of his life as too dangerous to
himself and to society to be at large.

All that has been said relates to the full-blooded Malays,
whether educated or not. The half-breed, quarter-breed, etc.,
may be of any grade of intelligence, according to that of their
white parents. Some of them are highly intelligent, cultivated
and refined, some are great artists and others are prominent
jurists. The better elements, who compare favorably with the
Anglo-Saxon, are only a small percentage of the population, —
less than a tenth of i%.

Now and then, the Malay character comes out strongly, even
in the upper classes, just as the negro character flashes out in
strong relief in our mulattos.

The Chinese mestizos are the most vigorous both mentally and
physically of all the half-castes in the Islands, as they are de-
scended from two allied types and are the most nearly adjusted to
the climate. '

The author disapproves of universal suffrage for those peo-
ples, adding that the Americans and others, who clamor for suf-
frage for all alike in the Philippine Islands, are unfamiliar with
the existing conditions there (American Medicine, August 5,

1905).

Studies of Endemic Cretinism.. — Drs. U. Cerletti and G.
Perusini : the subjects were studied in the Alpine valleys of
Northern Italy and great care was taken in the selection of the in-
dividuals. Seventy-eight individual histories are given, especial-
ly detailed where several members of the same family are cretins.
Nervous and mental diseases, alcoholism, syphilis and tubercu-
losis are not met with any more frequently among families af-
flicted with cretinism than among others. At any rate, these af-
fections cannot be considered as particular causes of endemic
cretinism. Nor is consanguineous marriage a special cause of en-
demic cretinism. While such marriage figure frequently in the
histories of the cases, there are villages there in which such mar-
riages are common, but in which cretinism is not common. If
such marriages have any relation to the genesis of cretinism, the
effect should be considered in its correct proportions. It is rela-

98 STUDIES OF ENDEMIC CRETINISM.

tively rare to find somatic degeneracies among the parents of
cretins. Abortions among mothers of cretins are quite frequent.
While extreme poverty is quite marked among the families of
cretins, it is also marked in families generally speaking in those
countries. It is noteworthy that families afflicted with more than
one cretin were rather in comparatively good material circum-
stances. In eight of the cases the fathers' mentality was below
that of the peasants in general. Mental enfeeblement among par-
ents of cretins is equally at a minimum for father and mother
respectively. Goitre, on the contrary, is frequent among the
fathers, but is the rule among the mothers of cretins. The utmost
importance is attached to this fact by the authors. Another im-
portant fact underscored by the authors is the large number of
cretin children born of the same mother. Out of 38 families ex-
amined this was the case in 25. The multiplicity of childbirths
is particularly illustrated in four families of cretins : ten child-
births at term and two abortions: 12 confinements at full term;
1 1 confinements at full term ; 1 1 confinements at full term and one
abortion. The mothers of these four families had nursed their
own children, artificial feeding being unknown in that country.
According to the Sardinian Commission, one-fourth of the
fathers and two-fifths of the mothers of cretins are afflicted with
goitre. The authors find that the number of mothers afflicted
with goitre in the Alpine regions studied is much larger than that
indicated by the commission.

Heredity as a cause of cretinism is considered, but in a special
light: thyroid insufficiency of the parent — particularly of the
mother — is a pre-eminent cause of cretinism. The maternal
hypothyroidism is gravely reflected on the offspring during em-
bryonic life, and causes cretinism. Stress is laid on the multi-
parity of mothers of cretins and the nursing of all the children
by those mothers. The relation of the hyperfunction of the or-
gans of generation to hypothyroidism of the mother is pointed
out: it is well known that before puberty boys and girls are af-
fected with myxedema in equal proportions, while after the on-
set of sexual function 83 women are affected with myxedema
against 17 men. The harmful effect of frequent maternity on the
thyroid gland is evident — particularly in mothers already afflicted
with hypothyroidism — as is the case in the countries where en-
demic cretinism prevails.

The subject is not only born with hypothyroidism, but is also
nourished with milk poor in certain elements derived from the
thyroid gland. The question of heredity in cretinism is crystal-
lized by the authors by declaring that it should be said of cretins

BIRTH RATE DECLINING STEADILY SINCE i860. 99

that they are born in a state of cretinism. In one of the prolific
families mentioned the two last born of the 10 cretins are the
most gravely affected ones. Besides, they presented myxedema
at the time of birth. They are twins and were so "fat" at the
time of birth that the local papers had notices about them at that
time. The skin of both children was pale, yellowish and edema-
tous at birth. The special heredity (in endemic cretinism is
demonstrated and myxedema at birth is pointed out by the authors
for the first time.

A large chapter is devoted to the study of the nosographia, and
the fallacy of many existing notions on the subject are brought
to light. There are many gradations of endemic cretinism, all
depending on the degree of maternal hypothyroidism during preg-
nancy and nursing respectively. The disease may manifest it-
self at birth, during childhood, adolescence, mature or old age".
A classification, differing from that generally accepted, is pre-
sented: it is based on the facts observed in this careful study.
The entire work covers some 165 pages and is illustrated with six-
teen tables of photographs (Annali dell'Istituto P sichiatrico ,
Roma, Vol. III., No. 2, 1904).

Birth Rate Declining Steadily Since 1860. — The Census
Bureau of the United States reports this steady decline in the
birth rate. At the beginning of the nineteenth century, the chil-
dren under ten years of age constituted one-third, and at the end
— less than one-fourth of the total population. The decrease in
this proportion began in 1810 to 1820, and continued uninterrupt-
edly, although at varying rates, in every successive decade. Be-
tween 1850 and i860, the proportion of children to women of
the child-bearing age increased, but since i860 it has decreased
progressively. The decrease has been very unequal from decade
to decade, but if the computation is made on the basis of twenty-
year periods, it has been regular. In i860, the number of chil-
dren under five years of age to 1,000 women, fifteen to forty-nine
years of age, was 634 ; in 1900, it was only 474. The proportion
of children to potential mothers in 1900 was only three-fourths
as large as it was in i860.

In the North and West there has been a more or less regular
decline, while in the South the decline has been less marked.

In 1900, for the United States as a whole, the proportion of
children was only two-thirds as great in cities as in the country
districts. In the North Atlantic division, however, it was almost
as great in the cities as in the country. In the Southern divisions
it is hardly more than half as large in the cities as in the country,
while in the Far West the difference is intermediate in amount.

IOo ON THE REFLEX OF THE "EXTENSOR DIGITORUM COMMUNIS."

In 1900, the proportion of children born of native mothers to
1,000 native women of child-bearing age was 462; the proportion
of children born of foreign-born mothers to 1,000 foreign-born
women of child-bearing age was 710, the difference indicating the
greater fecundity of the foreign-born women.

The proportion of negro children to negro women from 15 to
49 years of age was largest in 1880, and smallest in 1900. There
has been uniformly a larger proportion of negro children than
of white children. This difference more than doubled between
i860 and 1880, but in 1900 it was less than half of what it was
in 1880, and less than at any other census except that in i860.

Although the negroes have a larger proportion of children than
the whites, it has been noticed that the whites of the South have
a larger proportion of children than have the whites in other sec-
tions of the country (New York Times, Aug. 17, 1905).

On the Reflex of the <* Extensor Digitorum Communis."

— Prof. Arturo Morselli : Prof. Sciamanna was the first to in-
dicate what he called the "phenomenon of the middle finger."
The details regarding the points along the forearm where the
finger reflexes should be searched for are indicated, and it is
concluded as follows :

1. In normal individuals the finger reflexes are constant. One
or more fingers or the whole hand may be extended in the test.
The movement is always prompt, marked, of short duration, ceas-
ing with the return of the finger or hand to the original position:
In children under three years of age it is not always easy to ob-
tain the reflex. In old people the reflex is torpid.

2. In pathologic conditions the reflex is modified, becoming
exaggerated, decreased or abolished. When exaggerated, this
reflex is more marked than any other in the body, and the fingers
that generally give a slight response show marked exaggeration.
When the tonic tension is decreased, every reflex movement of
the fingers is sluggish or scarcely perceptible. When hypotonia
is marked, the reflexes both of the hand and fingers are abolished.

3. In some pathologic conditions the reflex may serve to make
a differential diagnosis, as between tabes and pseudo-tabes, trau-
matic, rheumatic and alcoholic neuritis : in toxic conditions the
muscular reaction is torpid, while in others it is exaggerated.
In hysterical conditions and in hystero-epilepsy it is common £0
find exaggerated excitability of the extensors, while in the epilep-
tic state and in neurasthenia the extensor reaction is sluggish or
abolished.

4. In toxic cerebral affections, as in morphinism, alcoholism,
alcoholic pseudo-paralysis, the reflex is torpid. In dementia pre-

CHRONIC CHOREA. ITS ANATOMOPATHOLOGICAL STUDY. I01

cox (hebephrenia and catatonia), in progressive general paralysis
and in mania the reflex is exaggerated (Rivista di patologia ner-
vosa e mental e, April, 1905.)

Chronic Progressive Chorea. Contribution to Its Clinical
and Anatomopathological Study, — Dr. Daddi : two cases of
Huntington's chorea are reported. In one case, four other mem-
bers of the family suffered from the same disease. In both cases
moral shock immediately preceded the onset of the disease and
in one case epilepsy was associated with the chorea. The dis-
tinguishing features of the microscopical findings were: numer-
ical decrease of the nervous elements of the cerebral cortex, the
maximum alterations being in the motor and psychomotor re-
gions, involving both the cellular elements and the nervous fibers,
the superficial zones being mostly involved (zonal layer, layer of
the small pyramidal cells, then the medium and large pyramidal
cells). Modification of the cellular structure, increase of the
neuroglia and vascular changes due to arteriosclerosis. It is
pointed out that the changes of the nervous system found are
characteristic of Huntington's chorea, that epilepsy cannot be
said to be the cause of those changes, because they existed in the
case in which there was no history of epilepsy; finally, although
both cases were those of old men, senility cannot be incriminated
as the cause of the peculiar changes found; the distribution of
the lesions quite differed from that found in senile cases ; in
senile cases certain convolutions show a zonal increase of the
third frontal convolution up to 79 years, while in the two cases
reported here those convolutions were involved like the others
as regards alterations. The author does not consider the peri-
cellular granular infiltration as peculiar of degeneration in Hunt-
ington's chorea, because this infiltration is not limited to the con-
volutions involved. The starting point of the pathology is in
the cerebral cells, the other involvements being secondary (Rivis-
ta di patologia nervosa e mentale, April, 1905).

A Case of Huntington's Chorea with Anatomo- Pathologic
Findings. -Dr. Carlo Besta : Huntington's chorea and Syden-
ham's chorea are two different clinical varieties :

1. Heredity is a constant factor in Huntington's chorea, many
generations of the same branch of family being affected with the
disease, whereas heredity is almost nil in Sydenham's chorea.
Besides, while Sydenham's chorea is generally due to some acute
infectious disease, especially to acute articular rheumatism,
Huntington's chorea is due exclusively to heredity.

2. Huntington's chorea is a disease of middle age, whereas

I02 THE PATHOLOGICAL ANATOMY OF EXOPHTHALMIC GOITRE.

Sydenham's chorea is principally a disease of childhood and
adolescence.

3. Huntington's chorea is always accompanied by mental dis-
turbances that grow progressively worse and end in dementia.
In rheumatic chorea, on the contrary, mental disturbances seldom
appear.

4. Up to the present time, no case of Huntington's chorea has
been known to end in recovery. Recovery is the rule, on the
contrary, in Sydenham's chorea.

The author's case is one of Huntington's chorea. Conclusions :

1. Huntington's chorea is a disease sui generis, particularly of
herditary nature, having no relation whatever to other choreas,
especially to Sydenham's chorea.

2. In the majority of the cases the anatomopathologic process
involves principally the vessels of the central nervous system.
Diffusion of the lesion ultimately causes leptomeningitis and con-
sequent alterations of the nervous elements.

3. The anatomopathologic lesions in Huntington's chorea ex-
plain the progressive dementia proper to this disease ; the motor
disorders, on the contrary, are not sufficiently explained {Rivista
Sperimentale di Freniatria, Vol. XXXI, No. 11, 1905).

The Pathological Anatomy of Exophthalmic Goitre. — Dr.

G. MacCullum : uniform changes have been found in the author's
twenty-eight cases. Characteristic changes were observed in: I,
the form and size of the alveoli ; 2, the character of the epithelial
cells ; 3, the character of the colloid ; 4, the vascular supply ; 5, the
connective tissue framework; 6, the lymphoid structures of the
thyroid. On the whole, the anatomical picture resembles closely
that produced by Dr. Halsted as a compensatory hypertrophy,
and it seems probable that this may be explained by some previous
injury to the gland, possibly from some foregoing infectious dis-
ease, such as influenza, etc., although a definite history of this
kind cannot always be obtained. Similar changes may frequently
be produced experimentally in dogs by the injection of some
injurious material into the thyroid, or even by the maintenance
during a considerable time of a suppurative peritonitis, in which,
apparently by the diffusion of some poisonous substance, there
occurs a destruction of many of the epithelial cells of the thyroid,
that are later replaced by the compensatory hypertrophy of the
remaining cells. The nature of the primary injury that may pro-
duce such a change in exophthalmic goitre is, however, not
always clear. No bacteria or characteristic cell inclusions could
be demonstrated by microscopic, cultural or inoculation methods.

RACE SUICIDE. 103

The parathyroid glands were examined in nine cases and were
found normal in all {Johns Hopkins Hospital Bulletin, August,

I905)-

Race Suicide. — J. R. Allen: the real reason for thedecrease
in the birth rate in this country lies in the slight value placed on
human life in its early stages. A human life begins at the moment
of conception. The human embryo is a human being at all stages
of its development. Yet, mothers all over the country and married
women make light of the act of feticide, practicing it extensively
because they wish to be free of the burdens of maternity. An un-
married girl is severely punished by the law for attempting or
accomplishing feticide, whereas the number of reputable women
who look with indifference and with indulgence on this crime
is starling. A campaign of education on this subject is urgently
needed, and it is too important to be avoided on the plea of mod-
esty. Every girl, before maturity, should be taught the physio-
logic fact that a human life begins at the moment of conception,
and that whoever ends that life, however early in its career, is
guilty of murder, and whoever seeks to end that life and succeeds
in the attempt is accessory to murder. Abortionists should be
prosecuted by the National Secret Service Department and all
their cases be tried in the United States Courts. The use of the
mails should be forbidden to all advertisements of doubtful char-
acter, whether carried in influential newspapers or sent by cir-
culars (American Medicine, August 5, 1905).

Persistence of Conciousness After Hanging. — According
to an exchange, the Rev. Emil A. Meury, pastor of the Second
Reformed Church, in Bowers street, Jersey City, has had ex-
perimental demonstration of the fact that consciousness persists
for some time after hanging: Paul Genz, who shot and killed
Clara Arnim, in Hoboken, and was sentenced to death for his
crime, had arranged with the Rev. Doctor to watch for certain
signals after he (Gentz) had been hung. It was agreed that
Gentz should twitch his hands twice, then once, and again twice
— one minute after the breaking of his neck. The Rev. Doctor
is reported to have said : "When Gentz was yanked up, his body
stiffened. About three-quarters of a minute passed. Then six
men, whom I had told what Gentz had said he would do, and I
saw the pinioned hands make the signals. The horror was too
much."

The Rev. Emil A. Meury is leading a crusade against capital
punishment in New Jersey.

104 MENTAL DISTURBANCES IN HOSPITALS FOR THE INSANE.

Inquest into the Frequency of Mental Disturbances
Among the Personnel of Hospitals for the Insane. — The

author of this research desires to remain anonymous and asked
Dr. Mignot to comment on this paper and to present it. In a
given hospital for the insane, the author had occasion to observe
twelve cases of insanity during a period of four years, in a per-
sonnel of 325 persons. This is a large percentage. Dr. Mignot
regrets that the heredity of the afflicted persons is not given. He
remarks that in France it is quite common for relatives of pa-
tients to become attendants in order to be near the patients in
whom they are interested. Under such conditions it is evident
that heredity, not environment, plays the major part in the onset
of insanity. Environment also has an influence, no doubt (An-
nates Medico-Psychologiques, No. 1, 1905).

Simulation of Mental and Nervous Diseases Among
Children.— Dr. Paul Moreau: simulation of mental and nerv-
ous diseases exists among children. At times the cause for simu-
lation is insignificant, while at others it may be of some impor-
tance. Most frequently children simulate by instinct, through
irritation or because they are ordered to do so. The form of
simulation is variable. If the child has had no example to go by,
he chooses some simple, natural form, as anger, lies, etc. If he
has had an example, he may simulate some real affections — hys-
teria, epilepsy, chorea, etc., delirium, mania, melancholia, etc. If,
without having had any example, the child chooses to simulate,
and he is hereditarily predisposed, he may manifest aberration of
sentiment. Children may simulate suicide. Simulation a deux
has been observed among children (Annates Medico-Psycholo-
giques, No. 1, 1905).

Researches into the Metabolic Changes in Dementia
Precox. — Drs. D'Ormea and F. Maggioto: this is the third of
a series of three papers on the subject. The average amount of
urine eliminated during the course of dementia precox is de-
creased and its specific gravity is lowered, the specific analysis
showing :

1. A decreased amount of the total amount of nitrogen elim-
inated in the urine.

2. A lowered ratio of the total nitrogen in relation to the urea.

3. A marked decrease of the total acidity of the urine.

The decrease of the total amount of nitrogen is not to be won-
dered at, as there is a marked decrease of the urea and the uric
acid: the total acidity is necessarily decreased, as the authors
had shown that the acid components were decreased in amount.

HEAD TRAUMA AND DEMENTIA PRECOX. IC5

The lowered ratio of the total nitrogen in relation to the urea is
one more argument in favor of the slowing of the metabolic proc-
esses concerning oxydation. The results uphold Kraepelin's
theory regarding the disease (Giornale di Psichiatria Clinica e
Technica Manicomiale, Nos. 1-2, 1905.)

Head Trauma and Dementia Precox, — Dr. A. D'Ormea pub-
lishes a case of a girl, 23 years of age, who became subject to
dementia precox some two weeks after she had sustained lacera-
tion of the bony part of the skull corresponding to the left frontal
region. He does not advocate surgical intervention in his case
because the symptoms do not correspond with any regional cere-
bral lesion, but are diffuse. He approves of surgical intervention in
similar cases — when the symptoms distinctly indicate that there
is a regional cerebral lesion — as was the case in Bonhoeffer's pa-
tient {Giornale di Psichiatria Clinica e Tecnica Manicomiale,
Nos. 1-2, 1905).

Severe Case of Tetanus Cured by Heroic Doses of Tetanus
Antitoxin — Dr. Charles F. Davidson : the patient, a boy, aged
12 years, while suffering from an eruption caused by poison oak,
went into a pond to bathe. The pond was usually visited by cattle
and hogs. Severe infection followed and the whole right side of
the scalp became filled with pus. Free incisions were made and
the pus drained ; the latter soon extended to the arm, and surgical
treatment alongside with antistreptococcic serum in moderate
doses — 20 cc, 4 times a day — ewre given. A week after the
infection, during which the moderate treatment with antitoxin
had been kept up, the patient showed alarming symptoms of te-
tanus, so that his life was despaired of. Sixty cc. of the antitoxin
were then injected under the scapula, this dose being followed
by 40 cc. of the same serum. The patient recovered — against all
expectations {American Medicine, August 5, 1905).

Believes in Peopling the Earth. — According to the New
York Times, July 25, Charles Leitstone, a pack peddler, left Eng-
land and a wife and twenty children, six years ago. He had then
been married twenty-one years. On his way to this country he
fell in love with another woman, but remained faithful as a father
and sent his family from $6 to $12 weekly for their support. Un-
fortunately, fifteen of the children died during six years of the
father's absence in this country. He then sent for his wife and
remaining children, and on their arrival in this country, told his
wife the truth about the other woman. The wife was lenient as

X06 FORM OF RED BLOOD CORPUSCLES IN DEMENTIA PRECOX.

to that episode and allowed him his freedom, 'but insisted oil
having her allowance to support her family. She was disap-
pointed, however, to find that she could not have any support
from her husband because he had had three children with the
other woman.

On a Special Form of the Red Blood Corpuscles in Dementia
Precox. — Drs. Pighini and Paoli :

i. The red blood corpuscles, treated with a special method,
present a characteristic structure, umbilicated form and larger
size than normal.

2. Such changes of the cells are not found in any other forms
of general or mental diseases. Similar conditions have been found
only in two chlorotic and one epileptic cases. The particular form
of red cells should not be considered as pathognomonic of de-
mentia precox, but simply as an index of grave alteration of the
metabolism in this disease (Rivista Sperimentale di Freniatria,
Vol. XXXI, No. 2, 1905).

Acute Anterior Poliomyelitis in the Adult — A. VanGe-

hutchten : a historic review of similar cases is made and a per-
sonal case of a woman, 21 years of age, is presented. Poliomye-
litis is always an infectious disease, the poison being carried by
the blood vessels. The localization of the poison in the gray sub-
stance of the anterior horns should be attributed to the special
vulnerability of the blood vessels in that locality. Whatever the
reason of that special localization, microscopic research shows
its existence beyond doubt : hyperhemia and engorgement have
been found in all the cases examined. The veins are the vessels
affected (Nevraxe, Oct., 1904).

Contribution to the Study of Hysterical Contractures. —

Dr. A. Piazza: the patient is a man, 27 years of age. He has
had several attacks of hysterical contractures of the upper limbs.
The spells set in with a sensation of tingling, then, after some
few hours of this disturbance, contracture of the both upper
limbs was complete. The spells lasted a few weeks each. Hot
baths and massage were the remedies used successfully (Annali
deiristituto Psichiatrico, Rome, Vol. III., No. 2, 1904).

A Case of Hydrocephalus and Acrartia. — Dr. A. E. Eng-

zelius : the skull cap was entirely absent, while the base of the
skull was perfectly developed. A membrane that apparently took
the place of the absent bones, was ruptured during labor, letting
escape brain substance and a large amount of fluid. The mother's
heredity is negative. No mention is made of the father's condi-

BOOK REVIEWS. 107

tion. The mother was a primipara, 23 years of age (Journal
American Medical Association, Aug. 19, 1905).

John D. Rockefeller Is a Total Abstainer : at a prayer
meeting at the Euclid Avenue Baptist Church, the "oil king" de-
clared that he had never tasted a drop of intoxicating liquor, and
advised young men to emulate his example in this respect.

Tweed's Son is Said to Have Committed Suicide. —

According to the New York Times, George K. Tweed, 40 years
old, the son of William M. Tweed, of New York, committed sui-
cide at the Connecticut Hospital for the Insane, on July 14, by
jumping from a third story window.

While in a Somnambulistic Sleep, Walked off a Car
of a Train That Was Carrying Him to Suspension Bridge:

according to the New York Times, June 17, Bernard Rademacher
accomplished the feat, and wandered about in the woods for two
days after the accident. When found, he was uninjured physic-
ally, »bu,t was taken to a hospital for mental treatment.

Kills Husband and Daughter and Commits Suicide. —

Mrs. Emma Winstandly, of New Albany, Ind., according to the
New York Herald, August 11, shot her husband in bed, drowned
her eight-year-old girl in a bathtub and poisoned herself by swal-
lowing carbolic acid. The woman had been melancholic for sev-
eral months previous to the accident.

BOOK REVIEWS.

Studies in the Physiology of Sex. Sexual Selection in
Man. 1, Touch. 2, Smell. 3, Hearing. 4, Vision. — By

HaVjELOCk Ellis. Davis Co., publishers, Philadelphia, 1905.
The chief stimuli that influence sexual selection come through the
four senses of touch, smell, hearing and sight. Touch is the most
primitive and most important, although it is usually the last to
make its appeal felt. Smell, that occupies the chief place among
many animals, is of comparatively less importance, although of
considerable interest, in man. Sight occupies an intermediate
position and is the most important of all the senses from the
human sexual point of view. Hearing is the most remote of all
the senses in its appeal to the sexual impulse, but when it inter-
venes, it is among the first to make its influence felt.

The four senses mentioned are considered in detail individually,
as regards their influence on and relation to sexual selection.

108 BOOK REVIEWS.

While the study is simple, it is highly interesting and instructive.

As the main purpose of human existence seems to be that of
reproduction, the function of our main special senses is directed
towards the furthering of nature's plan in this respect. The
author clearly demonstrates that touch, smell, hearing and sight,
in their various manifestations are factors in provoking the gen-
eric appetite, and he leads us through the epochs of gradual evolu-
tion or involution in the manifestation of the four senses among
various races, nations and peoples. A kiss is one. of the manifes-
tations of touch; and in China fathers leave off kissing their
daughters while they are still young children. Lombroso has
pointed out that maternal love has a sexual basis in the element
of suckling, and the author points out that suckling has an ele-
ment of touch. An instructive chapter is devoted to the con-
sideration of the cult of the skin among the classic peoples and the
antagonism of primitive Christianity to this cult, substituting for
it that of personal filth. Under these circumstances "morality
gained, but cleanliness lost." Then followed the period of the
use of cosmetics, essences, perfumes and — a fierce war with ver-
min— up to the seventeenth century, when elegant people washed
their faces "nearly every day."

Every nation has its special body smell, and the latter has its
special importance in the promotion of sexual appetite. The
odor of Australian blacks is less strong than that of negroes.
The Chinese have a musky odor, and the Europeans have a
stronger smell than have the Japanese. The smell of the body is
generally proportionate to the hairiness of the body and its pig-
mentation. A strong personal odor is so uncommon among the
Japanese that "armpit stink" is a disqualification for the army.
Many Chinese can tell by smell when a European has been in a
room.. There are some Europeans who can recognize and dis-
tinguish their friends by smell. The body odor of the castrated
differs from that of normal individuals. Among peoples inhabit-
ing a large part of the world's surface the ordinary salutation
between friends is by mutual smelling of the person. On the
Gambia, when a man salutes a woman, instead of shaking her
hand, puts it up to his nose and smells it twice on its dorsal side.
The emotional value of personal odor widely prevails through-
out the world. According to Marro, sexual offenders present a
larger proportion of anomalies of the nose and sexual organs
than do other criminals.

Perfumes are used, by the savages and civilized nations alike,
for sexual purpose. Musk and peau d'Espagne were used by the
most ancient nations and are still used to-day. Musk is a sexual

BOOK REVIEWS. ||U| 109

odor. The odor of the negress is said to be musky, and among
Europeans it is said to be characteristic of blondes. Musk is
particularly used in the Islamic world. The excessive use of per-
fume is injurious, causing marked fatigue and nervous exhaus-
tion. This fact is well known among workers in perfumeries.
Dementia precox is especially liable to affect dealers in musk.
The vocal cords of singers are sensitive to perfumes, the scent
of violets being especially injurious. Sexual inverts are pecu-
liarly susceptible to odors.

Music has an influence on the genesic psyche, and some sub-
jects have their erotic feelings aroused by listening to the choral
singing in the Roman Catholic churches.

Similarity of coloring and features is the rule in sexual selec-
tion. The most noted beauties are not necessarily of fair color-
ing : in England the noted beauties are dark of complexion. The
reason poets have always sung of fair beauties is that the ma-
jority of poets were of fair complexion themselves, and their
companions of the opposite sex were also of light complexion.
People of light complexion are more energetic and for this rea-
son, probably, more responsive to sexual life.

The subject treated of in this work is not only of special, but
also of general interest, and every educated man will find here
useful information about things with which he should be familiar.

General Psychology. With Physiological and Graphic Il-
lustrations, Twenty-one Colored Plates and 285 Illustrations.

— Prof. I. A. Sikorski. S. V. Kouljenko, publishers, Kieff,
1905 : A moderate number of introductory chapters on the
fundamental sciences are presented, indicating the major studies
in anthropology, anatomy, physiology, biology and sociology that
are necessary for the proper understanding of psychology.
Heredity and degeneracy are considered in proper proportions to
the subject in hand. The chapters on the psychology of nations
are of marked interest, although one cannot agree with the
author on all points of national psyche — as presented by him.
The physiologic characteristics of nations: the erect posture — re-
quiring a certain amount of energy — is most frequently assumed
by the nations of high civilization. The Mongolians, on the con-
trary, sit or lie down for prayer, etc. It has erroneously been
assumed that the sharpness of the five senses was more marked in
the lower races. Meyers shows that the acuteness of hearing, for
instance, is less marked in savages than it is in civilized nations.
Savages may recognize certain sounds, that they are expecting,
quicker than civilized nations would, but the acuteness of hearing

I JO &QO& REVIEWS,

m its absolute value is more marked in civilized nations. The
future of nations depends on their adaptability to elimate and geo-
graphical surroundings. The Mongolians, particularly the. Chin-
ese, are the most enduring race xn ^is respect : they are satisfied
with a simple and uniform food, are untiring in work and resist
tuberculosis and syphilis to a striking degree. The Europeans,
on the contrary, are threatened with the "white plague," syphilis
and alcoholism. The aborigines of Russia and America are sen-
sitive to alcoholism, while the negroes are sensitive to tubercu-
losis. For Americans (no specification is made) syphilis is a dan-
gerous and often fatal disease. The Jews are endowed with the
highest power of accommodation to climate, and Broca designated
tjfeis (pajity as anthropologic cosmopolitism. Intermarriage of
races does not always give similar results: the Turkish nation
gained in racial quality by intermarrying with white races, while
the -Greeks, with their high psychic qualities, perished proibaMy
on account of national intermarriage with Albanians, Slays and
Other nations. The Japanese present a particularly striking ex-
ampje of good results from their national fusion of Negro, Cau-
casian and Mongolian races.

The cranial capacity is smaller in the negro than in other races,
and the negro is characterized by elementary mentality. The yel-
low races are untiring, have well developed attention and perse-
verance and have distinguished themselves in the various indus-
tries and agriculture ; but regardless of their history of ten thou-
sand years' standing, they have not surpassed in deep intellectual
life. The whites are characterized by well balanced volition and
sensory function that harmonize with their high mentality.

Jt is difficult to know why the Greeks have disappeared. It is
presumed that the national mixture of the aborigines, who were
of dark complexion and eyes, and the new-comers, who are de-
scribed as having been of high stature with fair hair and eyes,
caused that nation to perish.

The Russian nation is the result of a mixture of Finns and
Slavs, with a slight admixture of Mongolians and Tartars. The
Russian marked characteristics are sadness and resignation.
The sadness is appreciable in the popular song. The emotional
side of the Russian Psyche may be compared to that of the Roman
races. The weakest trait of the Russian nation is the will-power :
the latter is less developed than in other nations, and this char-
acteristic strikingly differentiates the Slav from the Teuton and
Anglo- Saxon. The Finns have a strong will-power, but deficient
mental vigor.

The English nations hold the first place as regards stature, 4>ody

BOOK REVIEWS. Ill

Weight, physical development and strength. Will-power is de-
veloped better than in any other nation. The English-speaking
subject is enterprising, perservering and daring. The different
national elements that made up the present nation are responsible
for these conditions.

The Germans have some of the characteristics of the English-
speaking people, but rise higher than other nations in their scien-
tific achievement.

The marked characteristic of the French is high impressionable-
ness ; the latter is caused by high sensorial development.

The Jew is known for his perseverance, endurance and high
mentality that surpasses his emotional sphere.

Numerous chapters are devoted to the study of the anatomy,
physiology and pathology of the nervous system in relation to
human psychology. All the chapters are profusely illustrated
with cuts, photographs from life and of celebrated drawings and
paintings. The great effort to complement verbal arguments on
this science with graphic demonstration is praiseworthy. This is
one of the rare works on psychology in which the subject mat-
ter is treated Of in a direct, comprehensive and scientific manner,
while the reader's interest is held throughout the large volume
in quarto of 574 pages. The price of the volume is 5 roubles.

Grundlinien Einer Psychologie der Hysteric — Willy
Hellpach, Dr. Med. et Phil., Neurologist in Karlsruhe. W.
Engelmann, publishers, Leipzig, 1904. The work consists of a
heavy volume of over 500 pages, but little of what is said in it on
the subject of hysteria is based on facts. The reading of the book
is interesting, presenting almost a review of the various philo-
sophies of the past and present, the arguments adduced are clever
and plausible, but no clinical or pathological teaching is brought
forward as a basis of the study of hysteria. It is true that the sub-
ject the author has undertaken to analyze is difficult to handle,
but in matters medical we look to-day for facts. Unfortunately,
these are conspicuous by their absence, while an abundance of
theorizing fills the pages of the entire work.

Grundriss der Heilpaedagogik. — Dr. Theodor Heller, Di-
rector, Medico-Pedagogic Institution, Vienna-Grinzing. With a
plate of two figures. W. Engelman, publisher, Leipzig, 1904.
This is an interesting volume on the treatment of backward chil-
dren and youths. The author appears to be thoroughly familiar
with the subject of which he treats, basing his remarks, methods
and advice on well known clinical facts. Interesting clinical

112 BOOK REVIEWS.

tables of different authors are presented, showing the causes of
idiocy and imbecility respectively. In the study of his subject
the author considers his cases from the standpoint of the latest
discoveries in medical science. The volume is a useful book for
psychiatrists and general practitioners.

riental Diseases. Vol, I, General Psychopathology. Vol. II,
Special Psychiatry. A Textbook for Physicians and Jurists.

— Prof. P. I. Kovalevski. 5th edition. "Vestnik Doushevnich
Boleznei," publishers, St. Petersburg, 1905. The first chapters
are devoted to the study of normal psychology of man. The
reader is then gradually brought into the domain of elementary
psychiatry and finally psychiatry properly speaking is considered
clinically and pathologically. Prof. Kovalevski is well known
to the psychiatric world, and his works have long since been
known for their scientific merits. Prof. Kovalevski is an ac-
complished clinician, and the fact is thoroughly reflected on every
page of his work. One half of the volume is devoted to the
study of general psychopathology and the other half to the con-
sideration of special forms of mental diseases. The volume is
in 8-vo, 656 pages of closely printed small type.

La Simulacion en la Lucha por la Vida. — Dr. Jose Ingeg-
nieros. F. Sempere & Co., publishers. Valencia, 1905. This
is a small volume in 16, of 254 pages, but full of interesting
facts : simulation is practiced in all nature — wherever there is
struggle for existence. The color adaptabilities of the chameleon
is only one of the many similar adaptabilities in nature of all
that needs to struggle for an existence. Simulation is the basic
principle in commerce, in society, etc. The politician, the mer-
chant and all sorts of subjects are forced to simulate in order to
succeed in the struggle for existence. The little book is written
in an easy style and makes interesting reading based on interest-
ing data.

Lezioni Di Anatomia Clinica dei Centri Nervosi. —

Prof. G. Mingazzini : the first part of this work was presented
at the Congress. Nearly every page is illustrated with one or
more figures of the anatomy of the nervous system, and the sub-
ject is handled in a clear, practical way. Each lecture is com-
plete in itself and may be purchased separately. The entire work
will be a valuable addition to neurological literature.

The Journal of Mental Pathology.

Vol. VII. 1905. No. 3.

ON THE PATHOLOGY OF THE NEUROFIBRILS.

Drs. Ugo Cerletti and L. Sambalino.

(From the Laboratory of the Psychiatric Clinic, Royal University,

Rome, Italy).

In 1902, one of us undertook, in Prof. Nissl's laboratory, the
research into' the neurofibrils with a view to applying Bethe's
method to anatomo-pathology. The technique was scrupulously
carried out under the personal supervision of Prof. Nissl, who
had himself spent some time in Bethe's laboratory. After having
made several hundred normal and pathologic preparations by
the Bethe method, one of us gave up the application of the method
for several reasons: the endocellular network of Bethe was
brought out distinctly only in a few cells, while the pericellular
network was quite distinctly brought out by the same method
in many cells. This particular network Bethe identifies with the
neurokeratinic network of Golgi (Golginetze of Bethe).

In October, 1903, Ramon y Cajal published the first paper pre-
senting a resume of the new method of metallic impregnation
and successive reduction as applied to the neurofibrils. Although
the results are not always obtained by the same method, the
neurofibrils are brought to light with relative facility and fre-
quency in cells of the same section. This fact prompted us to
take up again our researches with a view to determine certain
eventual modifications of the new morphologic elements under
given pathologic conditions.

Firstly, we studied the spinal cords of rabbits after resection
of some of the spinal roots on one side. After a period of from
eight to fifteen days, the animals were killed and the segments
of the cords corresponding to the resected roots were taken for
study.

In the anterior horns we found that while some cells presented
neurofibrils, others did not. This was true both of the side
operated on and the normal one. On the side where the ex-
perimental lesion had been produced, however, it was evident, if

Il4 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 3.

examined with insistence, that there was a larger number of cells
without neurofibrils, or cells with badly stained neurofibrils, than
on the normal side. We did not pronounce ourselves definitely
on this subject, however, because there is generally a difference,
although sometimes slight, between the silver impregnation of
both halves of the cord. This difference could be observed both
in normal and pathologic specimens. It was impossible for us
to determine the cause of this difference of impregnation.

In face of the importance of this cause of error and the dif-
ficulty the comparative study of the normal and pathologic cells
presented, we considered it wise to limit still more the surface
of research to one even smaller than is that of the section of
the spinal cord in question. We chose for our study, therefore,
the cells of the external geniculate body of the optic thalamus.
We produced in that body axonal degeneration by excising the
parieto-occipital cortex on the same side, the surface of excision
covering 1.5 square centimetres. The healthy cells of the in-
ternal geniculate body of the same side were used for comparison.

We studied the thalamus of the rabbits operated on at various
periods, — from eight to twenty-five days after the operation, al-
ways being guided by comparative sections stained by the Nissl
method. The optic thalamus was impregnated with nitrate of
silver, either in its entire mass, after sectioning it in two by a
cut perpendicular to the axis of the 3-d ventricle, or after cut-
ting it in four parts by this and an additional cut passing in
the direction of the axis itself of the 3-d ventricle. In this man-
ner we succeeded in obtaining various degrees of impregnation.

From three to eight days following the operation we certainly
did not find any lesions of the neurofibrillary network of the
cells of the external geniculate body on the side corresponding
to the operation. There were some cells in this body that did
not present any trace of neurofibrils, while others presented slight
traces scarcely visible. Similar conditions existed, however, in
the geniculate body of the opposite side as well as in both in-
ternal geniculate bodies. Where the lesion had persisted for a
more or less long period of time, from ten to fifteen days, how-
ever, we found certain specific modifications of constant occur-
rence. Even in sections not marked, it was easy to recognize,
even under low power, the external geniculate body on the side
that corresponded to the lesion, the whole being of light-yellow
color, whereas the other thalamic ganglia were of a light-brown
color more or less marked.

Under a higher power it could be seen that a large number of
the cells of the external geniculate body, on the side of the lesion,

PATHOLOGY OF THE NEUROFIBRILS— Drs. Cerletti and Sambalino. u$

did not present any neurofibrillary network; nevertheless, there
were some cells in which coarse and rarified neurofibrils persisted..
In the other ganglia of the thalamus the number of cells in which
the neurofibrillary elements were not visible was quite smaller.

Where the lesions dated more than fifteen days there was a
marked retraction in toto of the tissue corresponding to the ex-
ternal geniculate body. The impregnation with the silver salts
was considerably marked here and this made it difficult to re-
cognize the nervous cells that were supposed to be altered.

In the other cellular bodies of the thalamus we brought to
light splendid networks of neurofibrils, especially in the large
cells near the middle line.

The meagre results obtained by the new experimental research
led us to give up our self-imposed conditions — those of obtain-
ing in the same section normal and experimentally altered cells.
Indeed, we found that even when we realized this self-imposed
condition the comparison between the different cells was not al-
ways satisfactory, as the impregnation varied from cell to cell.

We decided on a new method of procedure, that of ligating
the abdominal aorta — immediately above the renal arteries. The
animals used were rabbits, and they were killed 12, 24 and 48
hours after the operation. In some cases the ligature was taken
off after a period of from 4 to 8 hours, the animal being killed
36 to 48 hours after the first operation. It is well known that
under the above mentioned condition especial cellular chromolysis
in the lumbar region of the spinal cord is particularly pronounced.
We then compared sections as above with those of the region of
the cervical enlargement.

The positive conditions found were the disappearance of the
neurofibrils and the homogeneousness of the cellular protoplasm
in the cells of the lumbar enlargement. These conditions were
found forty hours after the permanent ligature and thirty hours
after a temporary ligature that had been applied to the aorta
for six hours (see Fig. 3). We could frequently find the neuro-
fibrillary elements in the cervical enlargement of operated animals
as well as in that of normal animals (see Fig. 1).

In 1904, as soon as Donaggio published his method of staining
the neurofibrils, we repeated our experiments with a view to
testing the value of the new method.

We obtained in normal tissues excellent preparations, showing
the fine endocellular network, thickening of the same network
around the cellular nucleus (cercine perinuclear e) and the con-
tinuous tracts of the fibrils (Hbrille lunghe), — all described by
the author in his numerous papers on the subject. Nevertheless,

Il6 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 3.

this method does not seem to us to give constant results either
in the same or in different pieces. We do not wish to affirm that
this depends on the duration of the process of staining with
theonine or on the difference of penetration of the molybdate
of ammonium into the various layers of the nervous tissues. In
a word, it is certainly difficult to obtain a continuous series of
sections of the same pieces showing a continuous and uniform
representation of the neurofibrils. Moreover, one often finds in
one normal section a mixture of cells with splendid network —
neurofibrils side by side with cells poor in this network or simply
a large network made up of coarse granulations. In a word,
these defective results are similar to those obtained with other
methods although, it should be admitted, to a much smaller de-
gree, the additional advantage of the Donaggio method being
that of showing more clearly the richness and delicacy of the
fibrillary network (See Fig. 4).

We give below in a few words the results obtained by this
method as applied to the research into the neurofibrillary altera-
tions in asphyxia of the nervous tissue (ligature of the abdominal
aorta) .

In rabbits that had lived from 30 to 48 hours after the opera-
tion, we found in the lumbar region of the spinal cord cells with
their neurofibrillary network far more frequently than we did in
similar specimens of sections prepared by the Ramon y Cajal
method.

In many cells the neurofibrils were less numerous than in speci-
mens called normal ; the fibrils were somewhat thickened, varicose
and frequently replaced by fine granulations disposed in series
(see Fig. 5).

We wish to remark that in our collection of normal sections we
have specimens of cells very similar to the above, although in a
different numeric proportion — at all events — smaller than in our
pathologic sections.

The results, properly speaking, are not as brilliant and varied
as we expected to find them in the study of pathologic modifica-
tions of so complicated an apparatus as is the neurofibrillary net-
work, and studied with methods so various. It is not our fault,
however, if a self-imposed rigid analysis of the different results
restrains us from making more generous conclusions.

If we consider that our conclusions apply simply to the experi-
mental research, in which the changes of condition are well known
and can readily be controlled, it would seem that when applied to
researches in pathology in general the reserve should be still
more strict. .

PATHOLOGY OF THE NEUROFIBRILS— Drs. Ceeletti and Sambalino. uj

Summary. — Some authors are striving to describe the mor-
phologic changes of the neurofibrils and put them in relation to
various experimental and pathologic conditions. It seems, how-
ever, that our present knowledge of the technique as applied to
the study of the pathology of the neurofibrils has not yet reached
the stage in which it would enable us to determine what consti-
tutes types of alterations representing various pathologic condi-
tions.

Naturally, there is nothing more suggestive than to see in the
pages of those works figures of cells, especially chosen, in which
are seen pale, thickened neurofibrils or replaced by more or less
coarse and diffuse granulations — alongside with neurofibrils rep-
resenting normal neurofibrillary networks.

We have already remarked that it is not at all difficult to find
similar morphologic modifications in sections of normal nervous
tissues. Nevertheless, we should distinguish two conditions : either
the neurofibrillary network presents positive or negative modifi-
cations. In the first case, — thickening, varicosity (see Fig. 2) and
abnormal tortuousness of the neurofibrils, — the morphologic modi-
fications, however, should be applied to pathologic conditions only
in cases in which a considerable number of the cells, not to say
all, present the given modifications, while such cellular modifica-
tion does not exist in the normal tissue or exists only in a small
number of cells. Without this standard the results become more
and more dubious in their significance; without such a standard
a comparison with an homologous normal part of tissue treated
by the same method is not decisive ; or one cannot be certain that
the lesion is not an artifact ; this is particularly true as regards the
impregnation obtained with the silver method'.

At all events, at present these positive modifications can only
constitute the starting points of a neurofibrillary pathology.

In the second case, when the modifications are negative, — that
is to say, the modifications that have been designated by the terms
disappearance of the netzvork, its pale stain, granular degenera-
tion (?) and granular disintegration of the neurofibrils, — terms
used to indicate the various pathologic metamorphoses of the
neurofibrils, one cannot be too careful in the interpretation of those
facts, because of the inconstancy of the positive results of impreg-
nation and stain. The metallic method furnishes particularly feeble
impregnation of some specimens ; this — not only in different sec-
tions but also in cells of the same section and even in different
parts of the same cell.

We have normal sections, treated by the Ramon y Cajal method
and even by the excellent method of Donaggio, in which we find

Il8 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 3.

cells with an excellent neurofibrillary network in one half of the
cytoplasma, while in the other half the neurofibrils are cut up into
granular fragments (cells of the anterior horn of the spinal cord
of rabbits, dogs, etc. ) . It is necessary to add that the groups of
pigments were totally absent in these cells. Moreover, it is quite
common to find a very pale endocellular network in all or in a good
many of the cells of normal tissue.

From what precedes, it is evident that in the negative modifica-
tions it is particularly necessary to have control cells in the same
section, that is to say, cells with neurofibrillary networks. Besides,
it is essential to have a constant and considerable numeric differ-
ence between the cells of the normal and pathologic tissues. If,
however, there are no normal cells that can be used for comparison
in the same section, it is necessary to obtain them in another, but
they should be treated exactly by the same method as are the path-
ologic cells. Even then, the result remains uncertain (see Fig. 3),
showing the aspect that present almost all the cells of the himbar
region of the spinal cord after ligature of the abdominal aorta in a
rabbit (Ramon y Cajal method).

The pessimism that permeates the above conclusions is inspired
not by any easy criticism, but is the result of our experience. We
consider it useful to thus present our ideas simply to prevent, if
possible, a repetition of useless work by many anatomopathologists,
such as has been done by the Golgi method — a method giving in-
constant results, but that nevertheless has given marvelous results
in normal anatomy.

We feel prompted to call to mind the danger suggested in Des-
cartes' aphorism, "la methode cree des resultats," whereas we find
this same aphorism applied by an enthusiastic and productive
author who has made researches into the pathology of the neuro-
fibrils,— an application made, perhaps, with a view to justify the
richness of his brilliant results.

Nevertheless, the methods of the last few years are progressively
showing us how to< obtain constant results. Our pessimism, there-
fore, should not lead us to inactivity, but, on the contrary, to
prudence in drawing conclusions from the facts observed.

Among the various methods, that of Donaggio gives splendid
results and has a great future.

Whatever has been said above, it seems that even if the perfec-
tion of the technique enabled us in the near future to obtain con-
stant results in the study of the neurofibrils — in pathologic states
— it would not be just to conclude that we should at the same time
be enabled to draw eventual vital conclusions as regards general
pathologic histology. There are two reasons for this :

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PATHOLOGY OF THE NEUROFIBRILS— Drs. Cerletti and Sambalino.

119

1. The pathology of the neurofibrils is only part of the pathology
of the nervous cells. Indeed, before determining the type of
cellular alteration it is essential to recognize not only the modifica-
tions of the endocellular network, but also the modifications of the
morphologic complexus of the cellular elements, — its volume,
chromophile bodies, the different prolongations, the nucleus and
its different parts, the nucleolus as well as the different immediate-
ly pericellular elements. These modifications can be seen only by
means of special methods.

2. Our present methods applied to the study of the neurofibrils,
according to our researches, bring to light modifications of the
cellular elements only after a relatively long period of time.

For the present, the classic method of bringing out even the
slightest pathologic alterations of the nervous cells remains the
Nissl method that is extremely sensitive. It enables us, for
instance, to bring out axonal degeneration with all certainty two
or three days after the onset of the lesion. With the methods of
to-day applied to the study of the neurofibrils, on the contrary,
these lesions cannot be brought out before the lapse of some ten or
twelve days. The absolute constancy of the reactions of methylene
blue in the different cellular types well fixed (^quivalentbilder)
makes the Nissl method the only one that can to-day render us
immediate service in the study of the pathology of the nervous
cells.

Rome, December, 1904.

EXPLANATION OF THE ILLUSTRATIONS.

Fig 1. Nervous cell, anterior horn, cervical region of the
spinal cord of a rabbit. Ramon y Cajal method.

Fig. 2. Nervous cell, anterior horn, lumbar region of the
spinal cord of a rabbit, six hours after the permanent ligature of
the abdominal aorta. Ramon y Cajal method.

Fig. 3. Nervous cell, anterior horn, lumbar region of the
spinal cord of a rabbit, 30 hours after the temporary ligature of
the abdominal aorta had been on for six hours. Ramon y Cajol
method.

Fig. 4. Nervous cell, anterior horn, cervical region of the spinal
cord of a rabbit. Donaggio's method.

Fig. 5. Nervous cell, anterior horn, lumbar region of the
spinal cord of a rabbit, 48 hours after the permanent ligature of
the abdominal aorta. Donaggio's method.

REMARKS ON A SPECIFIC HUMAN ENERGY
AND ITS ECONOMIC AND SOCIAL -
SIGNIFICANCE/

By LOUISE G. ROBINOVITCH, B. es L. (Paris), M.D.

Member, New York Academy of Medicine, Member, American Medical
Association, Foreign Associate Member Medico-Psychological

Society, Paris.

Every human being represents a certain quantity of potential
energies, the greatest part of which is developed and utilized in
the direction of* genesic function. Far from attempting to
delve into the mystery of this particular distribution and trans-
formation of human energy, it is rather intended here to take
it for granted that the destiny of man is similar to that of every
living cell — to live and to reproduce itself.

Reproduction is essential to every nation that desires to main-
tain its numerical strength among peoples. It is natural, there-
fore, to hear a peal of alarm arise when the likelihood of a pro-
gressive decrease of reproduction manifests itself in any given
nation. Disregarding personal opinions, and treating the sub-
ject solely from the standpoint of actual cause and effect, the
student of the question is provoked to derisive mirth when faced
with the various seriously vouched for causes of genesic insuffici-
ency of our society.

According to Lady J. C. H. Gordon, college education of
woman is responsible for the paucity of birth rate: only one out
of six graduates of Girton College, at Cambridge, marries. The
same percentage obtains among the graduates of Somerville
College, at Oxford. Since 1871, five out of eighty-five gradu-
ates of the Newham College, Cambridge, have married. These
were students in mathematics. Of sixty-four students in sciences
ten were married. Of sixty-four students in history nine married,
and of thirty-eight students o-f languages only one married (1).

In face of such direct data, therefore, education of women
is at once to be accepted as a dangerous source of national
sterility. No sooner does one become accustomed to this point
of view, however, than another study of the genesic psyche of

* Vth International Congress of Psychology, held in Rome, Italy, April
26-30, 1905.

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch. I2i

woman confronts us with quite opposite results. "The college
women, although marrying two years later than their sisters,,
cousins and friends, have borne a slightly larger number of
children per years of married life, and there is practically no
difference between them as regards the mortality of children,
health before and after marriage, o<r accidents of pregnancy.
These conclusions are nearly identical with those reached by Mrs..
> Sedgwick ten years ago concerning the English college women,,
as compared with their non-college sisters. The most striking
contrast between the two classes is the marked tendency of col-
lege women to earn their own living before marriage, to marry
college-educated and professional men, and in the fact of their
higher average income" (2). Another interesting item in the
study quoted above is that "the college women have a high
percentage of male children (55%) as compared with non-college
women (45%)."

We are thus confronted with opinions of two learned persons,
one claiming that education of women leads to' celibacy and
"race suicide", and the other claiming for the college woman
not only the opposite of this peril, but also* that, economically
speaking, the college woman is a blessing to her land because
she marries more wisely, has as many children as the non-college
woman and, besides, has more male children.

Many pages could be filled with names of equally learned
people who have published volumes, books and pamphlets' —
every one insisting on his particular point of view and demon-
strating that education of women is the cause of "race suicide"
and that it is not the cause of "race suicide". One side claims,,
among other things, that an educated woman who can support
herself is a double contributor to "race suicide" : because she
is materially independent and can remain single and because she
deprives a man of money, which, if he earned it, would enable
him to support a family. Some take a less clear and even a
gloomy view on the subject: in an effusion of sympathy for
the woman thrust on the battlefield of the higher professions,
they weep for her inferiority of mental capacity that must eventu-
aily doom her and thus cause "race suicide". Professor Zuc-
charelli is one of those who sympathize with nations overburdened
with educated women (3).

Turning to some other sources of information on the question
of "race suicide", one is confronted with the following duly
vouched for facts :

Among the poor the birth rate is high, but the infant death rate
is most shockingly higher in proportion to that in the well-to-do
classes.

122 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3

Among the wealthy and the middle classes the birth rate is
low and this contributes to "race suicide".

Commenting on the small proportion of children among cer-
tain classes of society, Dr. Inez C. Philbrick presents some
strikingly interesting views on the subject (4). Criminal abor-
tion is considered as one of the factors that leads to "race sui-
cide." According to the statements made in her paper, married
women engaged in industrial and professional pursuits do not
practice abortion. The morality among the single women earning
their living is high, and statements frequently made that they
extensively practice criminal abortion are unwarranted. Our
present social and economical standard is largely blamed for
"race suicide". The wealthy woman finds it inconvenient to
contribute to racial increase; and those who accept for their
standard of economic living the gaudy display of possession of
the wealthy cannot afford to rear children : hence — criminal abor-
tions and "race suicide" again.

Dr. Roland B. Curtin (5) puts some of the responsibility for
"race suicide" on the physician's shoulders. The modern ex-
pense for a confinement is high, he says, and young couples of
limited material means try to avoid having children on account
of the expense involved. He claims that the physician is in a
measure resopnsible for "race suicide" because the fees he charges
for confinements are too high — from $25 to $250 instead of from
$10 to $25 — as was the case when Dr. Curtin was a young man.
He further states that the greatest loss of childbirth is "among
the old, influential or rich families ; so much so that family after
family averages one, one and one half or two children to each
couple." He adds that quite recently a census was taken in
Wilkes-Barre, Pa., and it was found that in the Seventh Ward,
where the wealthiest inhabitants live, there was but a single
birth for the six months ending June 30, 1903. In Forty-Fort,
where many of the citizens are descendants of the old Con-
necticut settlers, there was in the same period not a single birth.
He further says: "I know of a town in New England with a
population of four hundred and fifty persons, among whom are
fifty married couples capable of producing children. In this
town the school contains a single scholar and no more in sight
to be educated." Among other factors of "race suicide" are
mentioned physicians' advice to women, teaching them how to
remain childless. Last, but not least, of the evils, according to
Dr. Curtin, is the hygiene taught in the public schools dissemi-
nating information about medical matters.

In the United States "race suicide" is generally ascribed to

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch. 12t,

the woman's disinclination to marry. The woman here has been
scolded for this disinclination by preacher, moralist, sociologist
and even President. We are all, or most of us, familiar with
the "girl bachelor" in this country, who heedlessly continues in
lier chosen social condition — heeding not in the least the chiding
of "race suicide" alarmists. No sooner do we become ready,
however, to believe that woman is the sole cause of "race sui-
cide" than we are astonished by the piercing of the ray of a
newer light on the subject, showing that in England the man
bachelor is responsible for "race suicide." Indeed, the man
bachelor in England is considered so obdurate a subject in his
determination to remain a bachelor that the daily press there, or
at least people who give their opinions in the daily press, con-
sider it useless to argue the matter with him, and suggesr
polygamy as the only hopeful measure for counteracting "race
suicide."

According to reports we have here (6), these significant words
were published in the English press: "In plain English, there
is in England at the present moment a 'sex famine/ which, un-
less the ladies are exported in millions, is likely to increase
rather than diminish," etc.

Summing up what is being said regarding the cause of "race
suicide," it appears that it is difficult to find any coordination
between them as they are given by the various authorities. Thus,
we are told that the following are some of the causes :

i. Education of women.

2. Lack of education of women.

3. Poverty (high death rate among children).

4. Wealth.

5. Limited material means attended by ostentation and envy.

6. Ignorance of medical matters among women.

7. Knowledge of medical matters culled from the books on
hygiene during school life.

8. Woman's unwillingness to marry.

9. Man's unwillingness to marry.

It seems useless to further tabulate the causes of "race sui-
cide" as presented by various writers. The few studies here
quoted are quite sufficient material for examination. The most
striking feature of all the studies quoted seems to be that their
respective authors do not seem to convey any exact idea as to
the object matter of their discussion. This prevents the
reader's following their arguments. Thus, these authors speak
of "race suicide" as of a new and startling phenomenon of our

124 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3 :

age — the majority of authors heaping abuse and insult on our
civilization, pointing at it as the greatest enemy of race procrea-
tion, etc.

Now, there is no prettier sight than that of a scientist hurling
insult at civilization and abusing woman for not bringing as
many children into the world as possible, telling his country that
unless woman shuns this civilization and resolves to be a "happy
mother of a large family" and that unless she, "like Sarah, a
biblical character" can always be "found in her tent" — race sui-
cide will triumph, and the country's government will pass into
the hands of the foreign element in this' country (vide Dr. Cur-
tin's paper above quoted). Such speeches are most elevating
and appeal particularly to our senses poetic and patriotic.

When we allow these feelings to subside, however, and look
at the grave peril under consideration in a calm manner, we are-
confronted with the other set of opinions already alluded to —
showing that in other countries than our own it is man who
chooses to enact "race suicide" — not woman. Besides, a
further search reveals the fact that a large number of the
sturdiest physicians of all countries unite in the outcry against
prolific marriages among certain subjects and go so far as to
recommend governmental interference, for the avowed purpose
of preventing a large number of marriages among certain in-
valid subjects. This particular outcry against marriage among
certain subjects will be considered later. For the present it
seems timely to remark that those who are alarmed by "race
suicide" seem to leave out of consideration the fact that "race
suicide" is not at all a peculiar visitation of our era. "Race sui-
cide" has existed from time immemorial — even among savage
tribes. A cursory examination of any work on sociologic
anthropology will demonstrate this to be a fact. See, for in-
stance, Letourneau's last work (7) and Enrico Ferri's work (8)..
Economic conditions have always forced every individual to pro-
vide first for himself — and then to consider whether he could
afford to bring offspring into the world. Paucity of food
brought about the general practice of abortion among savages.
Some Africans kill their twin children and drive the unlucky
mother from the house. Some tribes hold orgies on the oc-
casion of infanticide, and an instance is related wherein a mother
who tried to rescue her child from the hands of death was there-
after ostracized, and stigmatized with a title considered dis-
honorable—that of "child-bearer" (8)..

Hence, our poor civilization is not quite as much to blame as
are the foolish men who waste paper and ink on writing mislead-

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch. 125

ing statements. Civilization is not responsible for "race suicide."
The latter has existed and exists wherever human society has
existed or exists. In China, according to the well-known Chinese
woman physician, Dr. Yamei Kin, every mother is compelled by
national custom to nurse her child until it is three and one-half
or four years of age. If the mother becomes pregnant before
her last child has reached the stated age — her husband is chas-
tized on a public square for having been "unfaithful." Under
these conditions, the number of children born in any given family
cannot be numerous, and "race suicide" thus seems to me to be
enforced in a fashion peculiar to itself.

It seems, then, that there is a strong tendency in every society,
whether savage or so-called civilized, to avoid bringing into the
world too large a number of children. While superstition, cus-
tom or cupidity seem to be the outward motives of the respective
nations in keeping down the rate of child-birth, the real regu-
lating factor seems to be nature herself : nature does not intend
to cause suffering by overcrowding, underfeeding, and the dread
consequences thereof. At the bottom of all causes of "race
suicide" seems to be the dread of parents or potential parents
to face the awful moment when their offspring ask : "why have
I been born?"

The pitiable lot of the poor makes every honorable man wish
that there were fewer children per family, and consequent less-
ened misery for every one of its members; the excessive luxury
of the wealthy destroys the manliness of a large percentage of
the few children that do happen to be brought into the world.
Dr. Curtin (9) admits that "the children of the rich, who, petted,
mentally and physically emasculated, selfish and conceited, are
. poor material for the first rank in either war or peace."

In the light of these disclosures, it becomes somewhat difficult
to understand the inconvenience or calamity, as some consider
it, of a decreased birth rate. Particularly does this subject of
lamentation become incomprehensible in the face of the fact that
"race suicide" has always existed — among all nations and under
various civilizations.

Statistics show that to-day there is a decreasing birth rate in
all countries, the difference being only that of degree. Thus,
about the time of the Great Revolution, France had a population
of 25,000,000; to-day it has only 38,000,000 — a gain of 50 per
cent. During this period, the population of Great Britain, not-
withstanding the heavy drain of emigration, increased from 12,-
000,000 to 40,000,000, — a gain of 240 per cent. ; that of Germany,
from 15,000,000 to 55,000,000, — a gain of 270 per cent., and

126 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3

that of Russia, from' 25,000,000 to 100,000,000, — a gain of 301
per cent.

The current annual increase in the population of France by
excess of births over deaths is only about 30,000; that of Great
Britain, 325,000; that of Germany, 500,000. The French census
of 1899, shows that the gain in the population is now only one-
fifth of one per cent, per annum. The births for the census year
exceed the deaths by only 31,000, against 33,000 in 1898; 108,—
000 in 1897 and 93,000 in 1896 (10).

A more recent report on the decreasing birth rate in the United
Kingdom is contributed by D. Walsh (11) : "there has been
a fall in the total birth rate of the United Kingdom during the past
half century, with little change in the marriage rate. The fall
affects both legitimate and illegitimate births. The fall of the
last 30 years was preceded by a proportionate rise during the
30 years before, which may have been due to a wave of national
prosperity subsequent to free trade. The fall may be due to the
maximum limit of supportable population having been reached,
to the increasing tendency to postpone marriage, and (in minor
degree) to artificial prevention among the better-to-do classes.
The tendency among the patrician classes has always been towards
lessened fertility. Increased celibacy must be taken into consid-
eration, as well as the frequency of divorce and the constant
drain of soldiers and sailors. There is no trustworthy evidence
to show that prevention leads to grave physical and moral evils
in parents or the non-prevented issue of such marriages," etc.

From the above quoted statistics it appears that much of the
basis of "race suicide" talk is found in the selection statisticians
make of the progress of the birth rate of a special period of a
country's development — when the birth rate is quite high — as a
standard with which birth rates of different periods of other
nations are compared. To fully grasp the meaning of the sta-
tistics quoted above, therefore, it is well to analyze them in their
proper relative positions.

Leaving the birth rate in Russia aside for special consideration,
what meaning attaches to the birth rates in Great Britain and
in Germany respectively? During the periods here considered
both countries were in process of formation. As every one
knows, during such periods, characterized by new colonizatioi
and expansion, the formation of family ties and rearing of large
families is one of the greatest conveniences for social and in-
dustrial progress. The high birth rate decreases, how-
ever, as soon as the novelty of surroundings and social non-
restriction wanes. This condition is fully demonstrated in

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch.

127

countries of new formation, where the high birth rate was re-
markable even most recently as, for instance, in Australia; thence
comes the latest tocsin, as follows :

"The birth rate in the New South Wales Metropolitan area, that has
been decreasing from about thirty per thousand in the year 1894 t0 be~
tween 25.5 and 26.5 in the last three years, shows at present no increase.
The births relatively to population are much lower than the rate for July
during the last ten years" (12).

As regards the high birth rate in Russia : Prof. Antoine Marro
(13) gives an instructive exposition of data regarding the age
of marriage in various countries. In Russia, the percentage of
subjects marrying under twenty years of age is 32.01. This high
rate of young marriages stands alone in the list as compared
with similar percentages in other countries. The minimum per-
centage is 0.02, in Saxony (1 887-1 891) and the next nearest
maximum is 2.97, in Holland (1887-1891). The percentage of
marriages between 25 and 30 years of age is 6.94 for Russia;
the maximum percentage is for Sweden, 31.37; in Scotland it is
25.67 (1887-1891) and in Massachusetts it is 23.19 (1886-1890).

Explaining the percentages that he gives in detail for sixteen
countries, Prof. Marro says : "The peoples furnishing the largest
percentage of young marriages are dither those with highly de-
veloped sentiments of individual liberty and independence, as in
England and the United States, or those subjected to absolute
autocracy, as in Russia. The difference between the two is obvi-
ous nevertheless — the free countries furnishing the largest per-
centage of marriages between the ages of 25 and 30" (14). He
further states that in Russia the young subject as yet unfit for
marriage or procreation receives his wife from the hands of
his parents and in his precocious embarrassment loses the vigor
of youth and often reaches such a degree of servility as to accept
domestic and economic oppression without question. Gugliemo
Ferrero is quoted as saying that the employer lodges and boards
his workingmen, regulating the day's routine by the sound of the
gong, indicating the hour of rising in the morning, the hour of
commencement and cessation of labor, the hour of meals and
retirement, forbidding even recreation in any other than the pre-
scribed manner (15).

Prof. Marro treats in a masterly way of the evil consequences
of early and excessive sexual indulgences. "Autocratic govern-
ments", he says, "utilize this knowledge to fortify their own
existence. The Jesuits of Paraguay, who found marked con-
venience in holding in subjugation the Indians among whom they
worked as missionaries, caused their victims to be awakened at

-128 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3

midnight — by the sound of bells — and invited them to propagate

(16).

From what precedes it seems that a high birth rate without
some definite qualification is an unknown quantity that should
be well scrutinized before it is accepted as a desirable national
feature. In fact, a high birth rate seems rather an exception
serving to vary the usual and logical birth rate rhythm.

Prof. Marro tells us that it is a grave sacrifice for a family or
individuals to renounce the joy of procreation (17). If, there-
iore, families or individuals stand ready to sacrifice the joy of pro-
creation because they feel unequal to the sacred task, is it either
right or just for any one to condemn their course of action?

It is always well to consider any given proposition from all
points of view. We have seen the invalidity of the point of
view of those alarmists who consider "race suicide" as a special
and evil visitation of our particular era and civilization. The
broader, calmer and more judicious observers inspire the reader
with more confidence regarding the significance of "race suicide"
and furnish more material as well as useful data over which to
ponder. Thus, speaking of the various factors in the causation
of "race suicide," Dr. Inez C. Philbrick (18) says: We "maintain
a standard of sex relationship consistent only with barbarism.
We make merchandise of the bodies and souls of a half million
of our women. Venereal diseases in a majority of the adult
male population (for the prevalence of gonorrhoea is placed by
competent authority at 80 per cent.) exact tribute in health and
happiness of themselves, their wives and, in the case of syphilis,
of their children and unborn generations".

It is further stated in the paper just quoted that we have a
million defectives in our hospitals and charitable institutions ;
that according to Gihon, there are 2,000,000 active syphilitics in
the country and that the number of chronic alcoholists is far
greater (19).

"It should not be extolled, nor even admitted ethical, for a woman to
"bear a large family if it entails sacrifice of the precious heritage of living,
most certainly not if children be ill-born or handicapped in opportunity;
nor for a man to spend his years in drudgery denying every higher need
for their half-maintenance. Limitation of the number of offspring is often
a duty, but feticide is not its ethical method. Marital, as well as social
continence, is a crying need of the hour. Nature, unassisted by man, will
:in the process of time effect this limitation ; but for the diseased and de-
generate, it will be through the tragedy of survival of the fittest. Nervous
energy expended in intellectual and moral activities will lessen the number
while improving the kind of offspring" (19).

In his masterful "Presidential Address", Dr. Alder Blumer
{20), speaking of the prevention of insanity, says that it is

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch.

129

encouraging to notice that the lay press has taken to educating
the laity on the subject of insanity and marriage, pointing out
that prevention is the chief end of all medicine. He further adds
in part : "The making of human life is as serious a matter as the
taking one. Men and women do not realize how much insanity
is multiplied in the land by natural increase by birth" (21). He
also says that according to Dr. A. W. Wilmarth, Superintendent,
Wisconsin Home for Feeble Minded (Proceedings of the National
Conference of Charities and Correction, Boston, 1902) "the tend-
ency in degenerate families is to rear a larger number of children
than in those of average intelligence. 'Large families are found
among all grades of society, but investigation seems to indicate
that the higher the mental training of the parents, the less nu-
merous the family, as a rule'. And Kiernan has shown that the
average number of children in ninety degenerate families, which
he had observed, was eleven ; while multiple births occurred more
than ten times as frequently as in the population taken as a whole.
Thus it appears that while nature tends to check increase in the
case of gross bodily infirmity, it is otherwise where only the
higher faculties are involved in the degenerative process. And in
these days, when presidents of republics and of universities and
emperors are exhorting to marriage and singing paeans to fre-
quentative maternity, it is well that they ponder these things
Moreover, men and women of feeble intelligence are notoriously
addicted to matrimony and by no means satisfied with one brood
of defectives" (22). A case is then cited of a defective who,
in the course of examination, said to Dr. Blumer: "she is my
fourth wife, and I am her fifth husband".

Dr. Blumer concludes by saying that Legislatures "should
enact laws looking to the effective prohibition of the marriage
of the unfit". He quotes Dr. M. W. Barr, of Elwyn, Pa., who
says : " 'After all, there is a good deal of sentimentality and false
modesty in the repudiation of the idea of laws controlling in-
crease. We simply seek for the helpless, ignorant, irresponsible,
what the wealthy and indolent do for themselves' ".

Coming from the pen of so honorable a man and able a phy-
sician as Dr. G. Alder Blumer is, these statements should be
given careful consideration ; they show that he is an excellent
clinician and keen observer of psychiatric facts. Besides, he
does not stand alone as an advocate of restricted procreation.
Dr. Barr, who has been quoted, and many other psychiatrists of
high standing the world over, are trying to bring about a system
of restriction. Prof. Marro, also, states that degenerate men
and women are notorious for their exaggerated sexuality, because

I30 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3

degenerates are essentially instinct-individuals. They retain a
vigorous instinct of reproduction without having the force to
resist it or to harmonize it with social requirements. One of
his patients said to him: "I ■think that every man has his mission
in nature. For my part, I feel that mine is to procreate more than
any one else". This patient caused the birth of four sons, of
whom one was an epileptic, one insane, one a dypsomaniac and
one cachectic. The patient himself died insane (23).

In my own writings (24, 25, 26, 27) I have brought to light
similar clinical results. The degenerate families seem to ex-
pend most of their energies on the genesic function, their
whole lives being punctuated either by numerous abortions
(syphilis, alcoholism), or by unusually large numbers of off-
spring— all of whom, as a rule, are degenerates.

While I am thoroughly in accord with my colleagues as re-
gards their clinical observations, I am sorry to have to dis-
agree with them regarding the proposed enactment of "laws
looking to the effective prohibition of the marriage of the unfit".
I disapprove of such a law because, if honorably interpreted and
brought into effect, all kinds of defectives and moral imbeciles
would have to be forbidden by law to enter the married state. The
application of the law would be justifiable but practically im-
possible of application ; for one thing,— we have so many
moral imbeciles who occupy the highest possible positions (28).
Most of us are familiar with "the weak-kneed, the weak-backed,
the sycophants, the administrationists, the toadies, the affiliates
of the powers that be, the office holders, the profit-sharers of
gains wrung from the bodies and the backs of the unfortunates."
and others who "stand forth before the awakened intellect of
this generation and plead for the continuance of that which is
bad, of that which is secret, of that which is oppressive, of that
which hides itself under the cloak of authority, of pompous dig-
nity, of official immunity, of social exclusion and of profit-sharing
collusion and combination" (29). If we were to enact laws
as proposed it would become our particular duty to segregate
and prevent marriage among the numerous moral imbeciles of the
category just mentioned. For, as every honorable psychiatrist
will readily admit, the overwhelming functional and organic
harm done to society by these moral imbeciles can hardly be
calculated. Although their actual pathologic condition is not
generally understood, the clinician and psychiatrist know that
these moral deficiencies are as certain indices of moral per-
version and actual psychic invalidity as are the conditions that
manifest themselves in the moral stupor of imbecility or in the de-

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch.

131

linquency of common criminality. By their deeply diseased senses
they infuse and instill moral perversion and degradation not
only into the psyche of their own offspring — as is the case with
simple pauper imbeciles — but also into every member of their
society who is either their dependent or adherent. A segregation
by legal process of such defectives, however, cannot be prac-
ticed at the present time. And if such harmful moral imbeciles
cannot be brought under legal restraint, it would not at all be
fair for us, psychiatrists, to labor for the enactment of such laws
as are sometimes proposed.

To revert to the subject-matter of this paper, — the evils of
"race suicide", — it appears that the great social evil lies not in
the reduced birth rate, but in an overproduction of births that
are useless, costly to the State and dangerous to society. This
overproduction is apparent among the poor and the rich alike.
The poor furnish the country with 1,000,000 defectives for
our hospitals and charitable institutions [it is not stated whether
the 91,000 or 100,000 insane are included in this number (30)],
the rich furnish the children who "are poor material for the
first rank in either war or peace" (/. c, p. 4. 483) and the com-
munity in general is furnishing a population of which "venereal
disease in a majority of the adult male population exacts tribute
in health and happiness of themselves, their wives, and in the
case of syphilis, of their children and unborn generations" (/. c,
p. 489). According to Gihon, "there are 2,000,000 active syphi-
litics in the country", and "the number of chronic alcoholists is
far greater" (Dr. Filbrick, /. c, p. 490).

With these data facing us, can we ignore the stern, judicious
utterance of Dr. Alder Blumer that "the making of a human
being is as serious a matter as the taking one" (I. c, p. 13).

Dr. Blumer does not stand alone in this opinion. I have had
occasion to hear some responsible men of the highest standing
in this and other countries say the very same thing in
the same identical words before Dr. Blumer published his report,
and there are many more thinking men who are of the same
opinion — even if we do not see it published at large. From
all sides we are reminded of the fact that a great responsibility
hangs over the persons who bring children into the world. The
philosopher, the student in sociology, the psychiatrist and the
men who do their thinking without having a professional title
to their names, all agree on this point.

Although an enthusiastic adviser of marriage and an admirer
of numerous families, Prof. Marro (/. c. p. 521) vigorously in-
sists on the regulation of birth rate. He says : "we take so much

j32 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3

trouble to ameliorate the breed of horses, cows, clogs, etc., why
should not Legislatures turn their attention to the amelioration
of the generation of man, on whom depends the future welfare
of society'' (I. c, p. 521).

I have already expressed my opinion regarding the inter-
ference of law in the matter of genesic function, and while I
esteem most highly the opinions of the distinguished psychiatrists
whose names have been mentioned here, I do not see how such
laws can honorably be applied to all alike. Besides, the reading
of the arguments adduced here does not at all furnish any definite
information as regards the question of regulating marriage to
the best advantage of the individuals or the State. Prof. Marro
(30), for instance, tells us:

1. That marriages at an early age go hand in hand with po-
litical, religious and moral servility (I. c, pp 506, 524).

2. That marriage at the age of greatest virility and economic
validity, as is practiced by the English and Americans, is most
desirable (I. c, p. 526).

3. That the Latin male population loses the vigor of its early
manhood in precocious lascivious life, acquiring the force, and
virtue necessary to face the responsibility of married life at a
later period than does the English and American (/. c, pp. 526-

527)-

4. That in part, at least, the tenaciousness of the Jew and

the high level of his intellectual and economic potentiality are
due to his marrying at an early age (/. c, p. 522).

If, then, early marriage is bad for the quality of the race pro-
created, as seen in Russia, marriage at mature age should be good
for the race procreated. But concomitant loss of virility in las-
civious life, for the Latins, and the existence of some 2,000,000
active syphilitics, and 80 per cent, of the adult male population
infected with gonorrhea in this country (4) seems also to point
to wasted virility. Does this not indicate that marriage at mature
age is also bad for race procreation ? And if marriage at an early
age is conducive to servility among Russians, why is it conducive
to a high standard of intellectual and economic virtues among the
Jews? And if early marriage is bad, and marriage at adult
age is bad and marriage late in life is bad, at what age is marriage
to be advocated?

The light in which the question of marriage appears seems
to indicate that we ourselves have not studied the subject deeply
enough to be in a position to give advice on it. While there is
some foundation in the suggestion of psychiatrists to enact pre-
ventive medicine through legal channels, it is a question whether

A SPECIFIC HUMAN ENERGY— Dr. Robinovitch. j^

any real virtue would attach to such preventive medicine. As
matters stand, however, such preventive medicine would appear
to be a sort of premature burial of subjects who would have every
qualification for survival if preventive medicine were correctly
understood and properly enacted.

The greatest part of human energy is devoted to genesic
function. Parents who give birth to the largest number of off-
spring seem to utilize this energy in the least profitable manner
(idiot and imbecile children, epileptics or other degenerates).
This waste is principally due to the fact that nations have not
yet elevated the energy of genesic function to the dignity of
an energy. Other energies known to us, even of the meanest
grade, have long since been wisely utilized and their activities
based on the principle of the strictest possible economy. This
economic utilization has been brought about not through any
enforcement of legislative restrictions, but through steadily pro-
gressive human intelligence. Economic handling of genesic
function will, like the economic function of other energies, come
about through a steady and progressive intellectual development
of nations.

In the near future, I hope to consider some points regarding
the economic utilization of the genesic energy.

New York, October, 1904.

REFERENCES.

1. Prof. Antoine Marro. — La Puberte chez I' Homme et chez
la Femme, pp. 496-7, Schleicher Freres, Paris, 1901.

2. Prof. Mary Roberts Smith. — Statistics of College and Non-
College Women, Quarterly Publication of the American Statis-
tical Association, Marchrjune, 1900.

3. Prof. Angelo Zuccarelli. — La donna madre e lottatrice nella
societa odierna al lume dell' antroposociologia, La Scuola Posi-
tiva, August, 1904, p. 497-8.

4. Dr. Inez C. Philbrick. — Social Causes of Criminal Abor-
tion, Medical Record, September 24, 1904.

5. Dr. Roland B. Curtin. — How the Physician May Influence
the Declining Birth Rate, Bulletin of the American Academy of
Medicine, December, 1903.

6. Topics of the Times. — The New York Times, October 4,
1904.

7. Ch. Letourneau. — La Psychologie Ethnique, Schleicher
Freres, Paris.

134 THE JOURNAL OF MENTAL PATHOLOGY. Vol. VII, No. 3

8. Enrico Ferri. — LJ Omicidio nell'Antropologia Criminalc
(Omicidio Nato e Omicidio Pazzo. Con Atlante Antropologico-
Statistico), Boeca, Turin.

9. Dr. Roland B. Curtin. — L. c, pp. 482-3.

10. Ominous French Statistics. — New York Times, July 1,
1 90 1, quoting from Figaro, Paris.

11. D. Walsh. — The Diminishing Birth Rate, Medical Press
and Circular, July 13 and 20, 1904. Abstract in American
Medicine, October 22, 1904, p. 742.

12. The Australasian Medical Gazette, August 20, 1904, p. 415.

13. Prof. Antoine Marro, I. c, p. 524.

14. Prof. Antoine Marro., /. c, p. 524.

15. Prof Antoine Marro, /. c, pp. 526.

16. F. D'Azora, in Marro, /. c, pp. 506-7.

17. Prof. Marro, /. c, p. 529.

18-19. Dr. Inez C. Philbrick, /. c, pp 489-490.
20, 21, 22. Dr. Alder Blumer. — Presidential Address, Ameri-
can Journal of Insanity, Vol LX, No. 1, 1903, pp. 13, 14, 15.

23. Prof. Marro, /. c, p. 491.

24, 25, 26, 27. Louise G. Robinovitch. — The Genesis of Epi-
lepsy Clinically Considered. The Pathology, Prophylaxis and
Treatment of Epilepsy. Illustrated by Cases and Statistical
Tables, The Journal of Mental Pathology, Vol. II, pp. 24, 83,
140, 187 and 264.

Idiot and Imbecile Children. Various Causes of Idiocy and
Imbecility. Relation of Alcoholism in the Parent to Idiocy and
Imbecility of the Offspring. A Clinical Study, The Journal of
Mental Pathology, Vol. I., Nos. 1 and 2, 1901.

The Relation of Criminality in the Offspring to Alcoholism
in the Parents. A Clinical Study, Proceedings, International
Congress of Psychiatry, Paris, 1900.

On the Duty of the State in the Matter of the .Prevention of
the Birth of Crime and of Its Propagation, Journal of Mental
Pathology, Vol. I, No. 3, 1901, and Proceedings of the Fifth In-
ternational Congress of Criminal Antropology, Amsterdam, Hol-
land, 1901.

28. V. Magnan. — Recherchcs sur les Centres Nerveux, 1893,
pp. 145-6, 162.

29. Moral Crutches, Journal of Mental Pathology, Vol. IV,
Nos. 1, 2 and 3, 1903, p. j6.

30. Dr. S. Weir Mitchell. — Presidential Address, Abstract,
Journal of Mental Pathology, Vol. IV, Nos. 1, 2 and 3, 1903,
p. 80.

The Journal of Mental Pathology.

Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. VII. 1905. No. 3.

STATE PRESS, Publishers,
New York.

MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.

Address bulky mail matter to P. O. Box 1023, New York.

This Journal is published bi-monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.

Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelooe.

ON THE DISEASES OF SLEEP: CRIMES COMMITTED
DURING SOMNAMBULISM.

Dr. Biaute : During sleep the various functions of the
organism are variously suspended. The organic functions con-
tinue in a decreased state. The functions of relation undergo a
more marked interruption. The cerebral functions properly speak-
ing are unequally modified. Memory and imagination are
prone to exaltation, whereas attention, reflection and will are
dormant during sleep. Forgotten memories are revived but
are deformed and exaggerated. Vague sensorial impressions are
followed 'by disproportionate sensations and notions of time, space
and persons. Brown-Sequard's theory of reciprocal reaction of
the nervous centres explains the manifestations in certain forms
of pathological sleep. The overtaxed centre of memory may
communicate excitation to the motor centre and noctambulism or
dream of action may result. When this excitation is more marked,
the sensory organs may also be brought into activity — the general
sensibility remaining completely abolished. Under these condi-
tions we have a somnambulist : in complete darkness he dis-

I36 PERNICIOUS EFFECTS OF ALTERNATING CURRENTS.

tinguishes the minutest objects relating to his dream, showing the
most exquisite activity of the sensory organs, touch, sight, etc.,
while his general sensibility remains obtuse — irresponsive to the
rudest pricking, etc. A more marked excitation may bring the
intellectual faculty into play : the subject can talk, act and reason
as if he were in a normal state, but his will remains paralyzed, —
the subject being nothing but an automaton directed by sensorial
impulses that are followed by amnesia during the wakeful state.
This condition is called by Carpenter unconscious cerebration.
A perfect type of such cerebration sometimes follows epileptic
vertigo. In lethargy, on the contrary, cerebral activity is com-
pletely abolished, while the somatic functions only continue. The
latter may become so reduced, however, that the subject may read-
ily be considered as dead. Some lethargic patients wake up sud-
denly and return to the normal condition. This seems to indicate
that the trouble is due to general inhibition of the nervous centres
but not to a material lesion. The most remarkable case of leth-
argy of recent years was that of Bebeth : she fell into lethargy
when she was about to be arrested as a suspected infanticide, and
remained in that condition for twenty years. Dr. Gilles de la
Tourette studied her. During the entire period of twenty years,
she remained apparently lifeless, cadaveric and emaciated. One
day, she opened her eyes and moved her lips for the first time
in twenty years, saying "you pinched me." Her eyes then
closed and she died. In catalepsy cerebral function is abolished
but the centre of motility is active. In lucid lethargy the senses
and consciousness persist but the muscles are flaccid, paralyzed.
In such cases the subject, taken for dead, is a witness to all the
preparations of his own funeral, the most violent emotion alone
helping him cry out in terror against being buried alive. Con-
cluding these generalities, the author relates an unusual case
of somnambulism, during which the subject committed murder.
Complete amnesia of the accident followed during the wakeful
state, but the author succeeded several times in evoking the
memory of the act during hypnotic sleep (See Journal of Mental
Pathology, Vol. VII, No. i, p. 2j).

PERNICIOUS EFFECTS OF ALTERNATING CURRENT
OF HIGH VOLTAGE.

Dr. Millener has been consulted by some employees of the
great electric power houses of the Niagara frontier and finds that
these patients suffer from peculiar disturbances that he ascribes to
some unknown element or factor due to the electricity in the air
in those places. He says that continuous employment in the im-

PROF. TAMBURINI TO FILL THE CHAIR OF PSYCHIATRY I37

mediate presence of electric generators or transformers, where
the air is continuously and heavily charged with electricity or some
element caused by electricity of high voltage results in digestive
troubles. The patients so employed lose their appetites, their com-
plexion becomes almost chalky and there is pain and distress after
taking food. They are often obliged to go away on vacations in
ordert to become able to digest food in a normal manner
(Buffalo Medical Journal, July, 1905).

PROFESSOR TAMBURINI TO FILL THE CHAIR OF
PSYCHIATRY AT THE UNIVERSITY OF ROME.

The chair of psychiatry at the University of Rome is to be filled
by Professor Tamburini, of Reggio-Emilia.

Professor Tamlburini is one of the best known psychiatrists in
Italy. As Director of the leading Psychiatric Hospital for the
Insane and Institute for research into the nervous system, at
Reggio-Emilia, he has gained for himself world-wide fame. In-
deed, the high standard of that model hospital and Institute is
due to his untiring efforts. Besides the reforms introduced by him
into the largest institution for the insane in Italy, he is also re-
sponsible for the founding of the Rivista Sperimcntalc di Frcnia-
tria.

The University of Rome is to be congratulated on the good
choice made by the Ministry of Public Instruction in the matter of
selecting Professor Tamburini to fill the chair of psyschiatry.

PAPERS READ AT THE V-TH INTERNATIONAL
CONGRESS OF PSYCHOLOGY.

Held in Rome, Italy, April 26-30, 1905.
Sense Disturbance Following Extirpation of the Columns
of the Spinal Cord in Dogs. — Dr. V. Ducceschi describes
the technique of the operation. Ablation of Goll's col-
umn is simple as compared with that of Burdach's column. In
the latter case complete ablation cannot be performed without
encroaching on the gray substance. The ablation can very well
be performed on one side only. Four dogs were presented in
which unilateral and bilateral ablations had been performed, com-
prising lengths varying from 3 to 11.5 centimeters. In one dog,
that had sustained quite an extensive bilateral ablation, it was
observed, 2-4 weeks after the operation, that the posterior limbs
were almost immobilized or rigidly distended. When attempting
to walk, the animal dragged its posterior limbs, the dorsal sur-
faces of which were often turned downward. As soon as the
animal regains the power of locomotion, grave ataxic symptoms

138

PHYSIOLOGY OF THE CEREBELLUM.

are immediately observed in the posterior limbs : there is either
exaggerated or defective raising and lowering of the limbs, exag-
gerated abduction and adduction and time discord in walking, ac-
companied by alternate hypertonic and atonic attitudes. Some two
weeks after the animals commence to walk these disturbances
become somewhat attenuated, but persist indefinitely after that
time. The animals in question have been under observation for
four months. The ataxic disturbances become exaggerated in
running, walking upstairs, etc. Muscular force is decreased, the
animal becomes readily tired and exhausted : there seems to1 be
difficulty in sustaining the weight of the body with the posterior
limbs.

During the first days after the operation there may sometimes
be general hypoesthesia above the line of operation. In one case,
dolorific and tactile hyperesthesia was observed. During the sec-
ond period, — when the animal can walk on the posterior limbs, —
the simple tactile reflexes are in good condition. The tendon re-
flexes are somewhat impaired. Dolorific sensibility is decreased
in the posterior limbs as compared with that of the anterior
limbs ; and although it is difficult to analyze the tactile sensibility
in the dog, it is easy, nevertheless, to find that this sensibility is
unimpaired in the posterior limbs and perhaps the same as in the
normal side of the body. The most potent lesion of sensibility,
the one persisting permanently, as explained, is the impairment of
the muscular sense : the animal does not correct the abnormal posi-
tions given to the posterior limbs, or at the most, the correction is
only imperfectly made.

In two cases were observed quite marked zones of complete
anesthesia on one side of the body, somewhat above the line of
operation ; the disturbance was probably due to a radicular lesion
caused during the ablation of the columns of the spinal cord.

When the ablation is unilateral, the disturbances are at first
bilateral, but later are in great part reduced to the disturbances of
the operated side only.

The results of these experiments lead to the conclusion that in
the whole of Goll's and at least in the most inner and dorsal part
of Burdach's columns the tracts of muscular sense are prevalent
to the greatest extent without decussating in the greater part of
their length. On the contrary, the tracts for dolorific and tactile
sensibilities are either absent or rare in these columns. These re-
sults agree with those found by other observers with different
experiments. ; —

On Some Disputable Points Regarding the Physiology
of the Cerebellum.— Prof. M. L. Patrtzi said that although

SPECIFIC CHARACTERISTICS OF PASSION. 139

energetic discussion regarding the physiology of the cerebellum
had been going on for the last hundred years the question of its
physiological function was not yet positively clear. One of the dis-
puted points in connection with ablation of the cerebellum in ani-
mals is hypotonia alongside with "allure de coq." Luciani has
pointed out several facts in support of the muscular hypotonia ;
Ferrier and Monakow have presented facts denying its relation,
and Lewandowsky so explains the muscular relation that it
differentiates it from pure atonia. This diversity of opinions has
led the author to study the question graphically, obtaining tracings
of groups of muscles and single muscles on the healthy side and
that corresponding to the extirpated cerebellum. Although he
has obtained, by means of his special technique, tracings showing
that there is decreased muscular force on the side corresponding to
the operation, doubts whether this decreased muscular force is
due to a true defective sthenic influence of the carebellum ; he in-
clines to the belief that the decreased force is due to impaired to-
nicity. This theory has been advanced by Luciani himself, who had
previously advanced the idea of sthenic function of the cerebellum.
A third point of controversy touched on by the author is that re-
garding the re-enforcement by the cerebellum of impulses sent
by the cerebrum to the voluntary muscles. With experiments and
tracings he demonstrates that there is reason for the supposition
that cerebellar titubation may be looked on as a direct result of
muscular hypotonia. He thinks, with others, that it is not at all
necessary to look on the tremors and oscillations as absolute con-
sequences of absence of special cerebellar function destined to be
added to the elementary physiological stimuli coming from the
cerebrum. The author also touched on other points regarding
the function of the cerebellum.

Specific Characteristics of Passion — Prof. Th. Ribot
divides human sentiments into three principal groups: i, the
affective states properly speaking that express our appetites, in-
clinations and desires that are inherent to the psycho-physiological
organism of man. These states characterize normal life, preoccu-
pying consciousness feebly or to a medium intensity. 2, emotions,
characterized by abrupt and violent disturbance of the psychic
equilibrium (fear, anger, amorous outbursts, etc.). These are
reactions of the innate mechanism or manifestations of nature. 3,
passions are creations of man. Animals, children and primitives
have impulses, outburst, but not passions. The first characteristic
trait of passion is idee fixe that constitutes their nucleus. The
discussions regarding the affective or intellectual nature of a

140 GEOGRAPHICAL SURROUNDINGS, EVOLUTION AND INVOLUTION.

fixed idea does not influence the present subject. It is evident
that an idee fixe becomes a passion when it englobes sentiments
and tendencies to act. The second characteristic of passions is
their intensity (love, gambling, etc.), in which wishes manifest
themselves as acts and show no tendency to satiation. In static
passions (hatred, cupidity, cold ambition, etc.), the intensity exists
in a state of tension, incubation, often under the form of arrest
of motion. The third characteristic is their duration. Even the
shortest passions are of far longer duration than are pure and
simple emotions. The difference between passion and emotion
is like the difference between the acute and the chronic. Kant
expressed well the difference between emotion and passion : "emo-
tion is like the water that breaks through its dike," while passion
is like a torrent that eats into its bed more and more profoundly."

Influence of Geographical Surroundings and Heredity of
Acquired Characters on the Evolution and Involution of Peoples.

— Dr. A. Matteuzzi does not accept Spencer's views regarding
the evolution of peoples. According to Spencer, hereditary evolu-
tion is too strictly ascribed to the struggle for existence. Accord-
ing to the author, on the contrary, the influence of geographical
environment is most potent in the process of hereditary adapta-
tion. Spencer considers that when a psychic variation appears, it
is fixed by heredity. The author holds, on the contrary, that
psychic variations appear as consequences of geographical en-
vironment. On the basis of this reasoning, the author believes
that the future of peoples can be foreseen according to the physical
and tellurgic conditions of the countries in which they live. The
decadence of peoples is then demonstrated to have been the result
of geographical surroundings. The same geographical influence
that creates the heredity of acquired character and shapes psychic
development of peoples also leads to the decadence of the same.
This is demonstrated by the decadence of various historic peoples.
It is further shown that the very assimilation of psychic traits and
their perpetuation by heredity become insurmountable obstacles
to further assimilation of newer traits when peoples become com-
pletely adapted to their geographical environments : the new
psychic conditions are moulded to fit the old ones. It follows that
geographical conditions play an important part in the evolution
of heredity of nations and variety of geographical conditions is
the mainspring for evolution of new ideas.

The Fine Structure of the Nervous Fibre in Relation
to Its Function — Dr. Carlo Besta uses a special method of
fixation in order to demonstrate that there is a luxurious network

FIELD OF VISION IN THE INSANE AND DELINQUENTS. I4I

that runs through the myelin sheath of the peripheral nerve fibres.
The network is interrupted at the nodes of Ranvier and is prob-
ably of neurokeratinic nature. The study of this network in
various animals shows that its development differs with the ani-
mals, according to whether they can walk and enjoy certain func-
tional independence at the time of birth : this network is found well
developed in young chicks and others that are able to walk at
birth, while it appears later in dogs and rabbits — that are helpless
at birth; besides, in the latter cases the gradual development of
Metwork goes on as the animals near the adiult period. In rabbits
the structure becomes complete towards the 25th day, while in
dogs it is only towards the 40th day that the complete develop-
ment is accomplished.

There seems to exist, therefore, an intimate relation between
function and degree of perfection of the fibres. The author is
now studying these conditions as applied to various animals and
is trying to determine whether general significance attaches to
these conditions.

The Field ©f Distinct Vision in the Insane and in
Born Delinquents. — Dr. E. Audenino reports his experiments
on 97 subjects, 29 of whom were normal and 68 in pathologic
conditions. In normal subjects there is seldom narrowing of the
visual fieLd to a degree that distinct vision is impaired (13 per
cent.) ; in normal children the disturbance is of more frequent
occurrence than among adults. In the insane and the born de-
linquents, on the contrary, there is frequently narrowing of the
visual field (61 per cent.). Narrowing of the visual field for
white does not always coincide with narrowing of the field for
distinct vision. Narrowing of the visual field for distinct vision
is found in about the same proportion (jj per cent.) in adult
epileptics. Among young epileptics narrowing of the visual field
is found in smaller proportions (40 per cent.). In other psychiat-
ric forms (hysteria, alcoholism, paranoia) narrowing of the visual
field for distinct vision is found, but not as frequently as in the
preceding groups.

Importance of Psychotherapy in the Treatment c>f Sexual
Impulses. — Dr. E. Berillon considers the treatment of these
impulses in the young, and says that in most instances
the impulses are brought out by suggestion. The latter is par-
ticularly powerful because the subjects are in a condition of ex-
pectant attention. In all such cases, therefore, the suggested ideas
act as if the subjects were highly susceptible to hypnotic sugges-
tion. Hence, the tenacity and fixity of the impressions whether

142

THE RHYTHM SENSE IN PRIMITIVE PEOPLE.

they are normal or abnormal. Hence, also, the good results ob-
tained from psychotherapy in the treatment of abnormal sexual
impulses.

The Rhythm Sense in Primitive Peoples. — Charles S.
Myers experimented in the Torres Straits and in Borneo.
Lengthy explanations of the disposition of the experiments are
given, the conclusions being derived from tracings on a blackened
drum. It appears that the special tendency of the Murray Island-
ers is to quicken in repeating slow rhythm, while the special ten-
dency of the English is to slow in the slow rhythm-, Experiments
conducted in Borneo show how elaborately the execution and the
perception of complex rhythmical variations may be developed
among uncivilized peoples.

Hysterical Anesthesia to Fatigue. — H. Pieron reported
a remarkable case of a hysterical woman who could press the
dynamometer 50 times in succession with both hands, 28.7 kilogs
with the right and 27 kilogs with left one, making a total of 15 16
kilogs for the right hand and 1346 kilogs for the left hand. Such
a record is unusual and can only be explained by anesthesia to
fatigue. The patient is an old hysterical subject, having made the
rounds of the principal hospitals for the insane. Twenty-four
hours after the experiment she felt pain in the hands ; the pain
continued for two davs.

Study of Dreams During a Period of One Hundred Nights. —

H. Pieron made a study of his dreams and found that the
events of the day preceding the dreams had a considerable influ-
ence on the dreams ; dreams, however, are often of a delusional
character : the understanding of their nature is not as simple as
some would have them be. We do not recall all our dreams and it
is particularly difficult to remember dreams occurring during pro-
found sleep. A table is given showing how often the various
sensibilities and given ideation are brought into play during
dreams.

Contribution to the Study of the Psychology of the
Blind. — A. Krogluss : 1. Impressions of taste are less marked
in the blind than in those with good eye-sight. 2. Study by heart
of poetry, words, etc., is more difficult for the blind. 3. The words
implying sight-impressions have an emotional influence on trie
blind. 4. The representation images of hearing are better de-
veloped in the blind than those of taste. The lack of external im-
pressions through sight is complemented in the blind by impres-
sions of the other senses.

PHYSIOLOGICAL TOLERANCE TO HEAT AND COLD.

143

An Attempt to Determine the Physiological Concomit-
ance of Pleasure and Pain — Dr. Mario Govi presents a
plausible theory of special centres for pleasure and pain : centri-
petal currents of pleasure cause chemical integration in the nerv-
ous system. Pain or cessation of pleasure is accompanied by dis-
equilibration of the energies of the psychic centres and expenditure
of nervous energy characterized by chemical disintegration.

Limits of Physiological Tolerance to Heat and Cold in
Circumscribed Areas of the Skin. — Dr. Marco Treves finds
that it is impossible to determine this limit as regards cold, be-
cause cold acts as an analgesic at a freezing point. The limit of
this tolerance to heat varies between 45 and 50 degrees C.

The Appreciation of Time in Children. — Dr. Ida Faggiani
finds that children, like primitive peoples, first form notions of
the seasons before they do those of years, months, weeks and days.
The notion of the hour of the day is intimately connected with
physical stimuli of the digestive apparatus.

On Latent and Synchronous Thought. — Dr. Cesare Rivera
holds that two or more different thoughts may be synchronous in
the same person, although consciousness does not reveal the same.
This is one of the psychic phenomena that have not yet been ade-
quately explained.

TRANSLATIONS AND ABSTRACTS OF CURRENT

LITERATURE.

A Rare Case of Reflex Epilepsy. — Dr. Ouspenski : A
girl, 17 years of age, had been subject to epileptic fits beginning
with her first menstrual period, when 14 years of age. The at-
tacks took place at the time of every menstrual flow. A thorough
examination showed that it was not hystero-epilepsy. All the
organs, except the genital apparatus, had been examined and
found normal. The usual bromide treatment proved useless.
When 19 years of age, the patient married against the advice
of the author. Married life brought her no relief: the attacks
continued to take place the first day of menstruation. The genital
apparatus was now examined and found perfectly normal. The
patient had been invited, however, to present herself for an ex-
amination three days before the onset, of the menstrual flow. At
that date, the entire genital apparatus was considerably engorged :
the ovaries were large and sensitive, the uterus and vagina were
engored and the external genitals were red and distended. The
patient had a fit in the author's presence, and he was now con-

144 PATHOGENESIS OF ACROMEGALY.

vinced that the epilepsy was genuine. He then scarified the
uterus, drawing a tablespoonful of blood; the same operation
was repeated the next day, and on the third day the flow set in —
without there being any convulsive attack. There were no at-
tacks between the menstrual flows. Before the following men-
struation the patient was again subjected to bleeding from the
neck of the uterus during three successive days. The flow set in
for the second time without any epileptic attacks. For seven
successive months the patient presented herself for examination
four days before the onset of the flow, the organs were found
engorged as on the first examination, sacrification and bleeding
was practiced, drawing one half ounce of blood each day, and the
menstrual flow was accomplished normally without any epileptic
attack. The author now decided to omit the usual preventive
bleeding but, in order to avoid any psychic effects on the part of
the patient, he pretended to perform the operation as usual when
she presented herself for the usual scarification. The operation
was usually painless, and the patient did not suspect the author's
test. She submitted to the operation during three successive days,
as usual, and when the flow set in on the fourth day there was a
severe epileptic attack. According to the family, the attack' had
been more severe than any of the previous ones — before the treat-
ment had been instituted. Before the succeeding flow the bleed-
ing was performed during three successive days preceding the
onset of the menstrual flow, as usual, and there had been no
epileptic attack. The author then suggested the use of mustard
and hot applications to the abdomen, to replace the bleeding. This
the patient refused to do, preferring the old treatment. There
were no attacks as long as the bleeding was performed as in-
dicated. The author then had to absent himself, and referred his
patient to a colleague. The patient refused to go to a new phy-
sician and had epileptic attacks accompany every menstrual flow.
In the absence of the author, she finally decided to resort to hot
applications and mustard poultices. This brought her relief, and
there were no epileptic attacks with the menstruation.

The author does not know of any similar cases of epilepsy that
could unhesitatingly be called reflex epilepsy (Vestniff Dous-
hevnich Boleznei, No. 5, 1904).

On Experimental, Secondary, Hypertrophy of the Pitui-
tary Body. Contribution to the Study of the Pathogene-
sis of Acromegaly Dr. Guido Guerrini: The history o£

acromegaly in medical literature is carefully traced. Marie's
conception of the pathogenesis of acromegaly is accepted by the

PATHOGENESIS OF ACROMEGALY. 145

majority of neurologists; many cases have been published, in
which acromegaly is ascribed to lesions of the pituitary body.
The author's experiments lead him to think that the lesions of
the pituitary body are secondary in nature. This opinion is sup-
ported by the fact that the pituitary body was found normal in
many cases of acromegaly. He admits that under the condi-
tions in question the gland may remain intact under various cir-
cumstances : the condition of the gland itself, a non-advanced
stage of the disease or when there is compensatory function by a
gland similar to the pituitary body. According to some authors,
the thyroid gland and the pituitary body may supplement each
other's function. The author's own experiments lead him to ac-
cept this opinion. He applies his findings, however, in a way
different from the accepted one. According t© him, lesions of
the pituitary body may be secondary. This is demonstrated by
numerous experiments on animals. His experiments cover in-
toxication with endogenous as well as with exogenous agents,
For the latter he used diphtheritic poison, for the former — tying
of the intestines or the biliary duct. The serum obtained from
the infected animals was then injected into healthy animals. He
concludes from these experiments that there is no material
difference between the effects of the endogenous and exogenous
poisons on the pituitary body. In some cases intoxications
caused hyperfunction and in other — hypofunction of the pitui-
tary cells. Anatomical details of the experiments are given. Gen-
erally speaking, endogenous or exogenous infection excites the
function of the pituitary body. If the irritation is of long dura-
tion, hypertrophy and hyperplasia in the parenchyma of the
gland follows. The author concludes by saying that the notions
of the relation between pituitary body and acromegaly should be
adjusted in face of the experimental results obtained by him.
There is a similarity, he says, between the opinions of those who
consider auto-intoxication as a cause of acromegaly, and his own
opinion regarding the effect of intoxication on the pituitary
body. On an average, the intoxication of the animals lasted 90
days before the glands were analyzed. In acromegaly, of course,
the intoxication lasts much longer.

The metabolic changes in subjects afflicted with acromegaly
are considered of importance. They should be studied. Gly-
cosuria has been found in a large number of cases, but it was
not found what particular organ, other than the gland, was af-
fected. Hemoglobinuria has also been observed, but we have
no definite studies of such cases (Rivista di Patologia nervosa
e mentale, November, 1904).

I46 PROBLEMS AND THEORIES RELATING TO SLEEP.

Problems and Theories Relating to Sleep. — Dr. Claparede
says that up to the present time sleep has been considered from the
exclusive point of view of an immediate physiological mechanism,
but that it seems to him that a biological basis underlies the phe-
nomenon. A number of observations, that cannot be explained by
the classic notions of sleep, support his point of view. Infusoria,
for instance, do not seem to sleep ; Hodge and Aitkins observed
the Vorticella gracilis uninterruptedly during 21 hours, and de-
clare that this animal does not rest or sleep, that the cilia kept
on their motion throughout the observation. Sleep is not always
proportionate to fatigue or activity. Birds, for instance, are ex-
ceedingly active, perform a considerable amount of work, but
sleep very little. According to Brehm, the longest day is too short
and the shortest night is too long for them. All birds wake up
early in the morning and are awake several hours during the
night. Some birds can keep on flying several days in succession
when at sea, without resting and consequently without sleeping.
The author is of the opinion that sleep is an active and positive
function, but not a consequence of organic exhaustion. Under
normal circumstances sleep precedes exhaustion and often exhaus-
tion produces insomnia. Sleep is, therefore, a function of defense,
an instinct that induces inertia in order to prevent excessive activ-
ity that would end in exhaustion : we sleep not because, we are
intoxicated or exhausted, but in order not to become exhausted.
A series of facts and reasoning lead the author to the belief that
sleep is simply an instinct subjected to the law of "momentary
interest." Some of the facts speaking against sleep being a result
of exhaustion are : absence of parallelism between sleep and ex-
haustion, the periodicity of sleep, possible postponement of sleep
when desired, suggestion of sleep, partial sleep, variety of the types
of sleep of animals, etc. This point of view also permits to con-
sider hybernal and estival lethargy as a variety of ordinary sleep,
the type of which is probably due to a phenomenon of secondary
adaptation.

The Mechanism of Sleep consists of a reaction of disinter-
estedness in the event of the moment. Neither the irritability nor
the receptivity are abolished during sleep as is generally be-
lieved!: the reactive function is abolished — interest being lost in
the events of the moment. The psychology of dreams justifies this
line of reasoning.

This biological theory of sleep can serve as a basis for the study
of hysteria on a biological foundation ; inhibitory function of de-
fense seems to characterize both conditions {Archives de Psychol-
ogic, Nos. 15-16, 1905).

ON THE FIBRILLARY STRUCTURE OF THE NERVOUS ELEMENTS. jAy

On the Fibrillary Structure of the Nervous Elements.

— Dr. M. I. Gourevich : Ramon-y-Cajal's method was used.
The neuro-fibrillary apparatus of the most important cellular
types were studied. Sections of the spinal cord, medulla oblongata,
cerebral and cerebellar cortex of rabbits were used. The fine
neuro-fibrillary network of the cells could distinctly be seen. The
fibrils are uniform in thickness. The network can be seen well
with an immersion lens. The larger cells of the spinal cord and
medulla oblongata (motor cells) present a markedly thick fibril-
lary network; the fibrils are anastomosed by a secondary set of
finer fibrils, — the whole making the network appear closely set.
Many cells present a double network, — peri-nuclear and peri-
pheral. The fibrils penetrate into the thickness of the cellular
protoplasma and closely adhere both to the nucleus and the peri-
phery of the cell. The general network sends off tufts of fibrils
into the dendrites. In these tufts the fibrils are so thickly set that
it is difficult to see the fibrils of the secondary set.

In the small cells of the spinal cord and medulla oblongata
(especially in the spindle cells) the endocellular network is not
quite as well developed as in the cells mentioned above ; besides,
there is no differentiation into a perinuclear and peripheral set;
the primary fibrils predominate, while the secondary are not
quite marked.

The cells of the gelatinous substance of Rolando are ap-
parently free from the fibrillary structure.

Network in the pyramidal cells of the cortex : in the main
dendrite the fibrils run parallel to one another, the secondary
fibrils being scarcely visible. A similar aspect of the fibrils is
seen in the part of the cell near the main dendrite. The main
part of the cells is taken up by the network. In the axis-cylinder
the fibrils are closely set. The secondary dendrites of the pyra-
midal cells also have fibrils.

In the cerebellum, the Purkinje cells also present fibrillary net-
works. Here, the pericellular do not connect with the endocel-
lular fibrils, the two being divided by a distinctly unstained
layer.

The fibrillary network may be considered as a special appa-
ratus of the nervous protoplasma. Further studies of the ner-
vous elements should be made, however, for the elucidation of
the mechanism of their workings {Journal Nevropatologii i
Psychiatrii Imeni Korsakova, No. 5, 1904).

The Question of Suicide. Medico-Psychological Sketch

I. M. Reichers : An exhaustive collection of opinions of various

I48 PSYCHOLOGICAL NOTES ON THE PAHOUIN NEGROES.

thinkers regarding suicide is presented. Some of the ancients
considered suicide as a holy duty. The Celts and Gauls did not
prize life. This is indicated by their customs of receiving the
new-born infant with wails and cries, while death in a family
was celebrated by singing songs. Buddha taught that the body
and its functions were unclean and that death, particularly sui-
cide, did not imply an end of life but rather a transition of the
soul to a better world. During the famine of his time he ended
his life in order to furnish meat for his fellow beings. The
Chinese, Japanese and Hindoos cheerfully committed suicide by
most atrocious methods. Collective suicide was also in vogue
in olden days : five hundred philosophers committed suicide when
it was ordered to burn the works of their leader, Confucius.
The Jews and Greeks, on the contrary, attached importance
to life. Aristotle, Plato and others taught that it was a shame
ito shrink from the various phases of stress of life and seek
refuge in death. In the latter days of the Greek Republic, how-
ever, when the Roman oppression was severe, suicide came into
vogue : the poetess, Sappho, committed suicide, and Seneca
taught that the right to live or die was an individual privilege.
He committed suicide by cutting a vital artery while taking a
bath. Voltaire said "la vie est un opprobre et la mort est un
devoir". Rousseau, Shakespeare, Schopenhauer, Leopardi, Hart-
mann and others approved of suicide. Krachkovsky defined life
as being "a multitude of foolish hopes in the future and a mul-
titude of absolute foolishness in the past." Tolstoi said that
life was nonsense. Goethe said of his life : "it consisted of
throwing a stone and of picking it up again". Rubinstein said:
"struggle whets the appetite for life". Peter the Great and
Catherine II severely condemned the act of suicide. According
to the psychiatrist, Sikorsky, ^4 to 2/3 of suicides are psychically
well subjects. Some claim that suicide to-day is due to stress of
life, lowered moral ideals, etc. A large number of authors,
however, consider suicide as an abnormal act (Naouchni Archiv
Vilenskoi Okrongenoi Lechebnizi, Nos. 1-2, 1904).

Psychological Notes on the Pahouin Negroes.— M-lle
Alice Degallier has had ample opportunity to study the children
of these negroes as a missionary teacher in Congo. The children
are particularly capable of reading with facility writing and print-
ing turned upside down. When a book turned upside down
is given to them to read, they make no remark, take it as a matter
of course and readily read correctly. Adolescents, however, who
had learned to read during childhood, cannot read writing or
printing turned upside down with as much facility as children can.

PSYCHIC SUFFERING OF WOMEN.

149

The children also write upside down as if it were natural to do so.
They are particularly prone to write upside down the letter i and
figures 2, 3 and 5. This facility to read and write upside down is
ascribed by the author to the vivacity of their intelligence. These
negroes are excellent imitators, and their handwriting seldom
retains the childish characteristics for any length of time, but
their caligraphy closely resembles that of the missionary who has
taught them to write. The sense of color is highly developed as
regards intensity, but not so as regards quality. Memory is highly
developed, especially auditory memory for melodies, words, songs,
etc. Gesticulations and facial expression are highly developed.
The author had great difficulty in distinguishing one pupil from
another until she learned to distinguish them by their respective
facial expressions. Their sense of right and wrong is rudimentary
or even wanting, but they are markedly affectionate {Archives de
Psychologic, Nos. 15-16, 1905).

Psychic Suffering of Women as One of the Forms

of Sexual Psychopathia. — Dr. Jakovlev: The title of the
work is misleading, as the author devotes his interesting and
exhaustive paper to the elucidation of the fact that women are
innocent victims and sufferers if caught in the immoral net of the
sadist. Although realizing the fact that under the present con-
ditions it is difficult and even impossible for woman to learn how
to distinguish between an honorable flirt and a sadist, he gives
her decided advice how to act towards him wrien she meets him:
she should slap him in the face and loudly proclaim her protest
against his so-called amorous demonstrations. The sadist has
no sense of morality, justice or courage, and in his cowardly way
he will make attempts to defame the good name of woman who
repulses him — no matter whether she acts openly and bravely or
timidly and modestly. Woman's freedom of to-day and the con-
sequent tolerance of flirtations are a great help to the sadist, who
is thus enabled to carefully work his ways of indecency. Flirta-
tion is vigorously condemned by the author from all points of
view. Pure and true love among the young does not need the
sensual support derived from touching each other's feet under the
table at which one dines, etc. Advice is given to men to practice
more reserve towards woman than even society and woman herself
demand; and in this way, the author claims, the woman would
not acquire habits of flirtation that may eventually facilitate
the sadist's advances towards her. N It is also advised to instruct
woman regarding the existence of sadists in society — even when
it is of the highest class and standing. The law should deal with
the sadist himself (Vestnik Doushevnich Boleznei, No. 2, 1905 V

150 RELATION OF GENERAL PARALYSIS TO TABES DORSALIS.

From the American Journal of Insanity, April, 1905.
1. A Contribution to the Study of the Relation of
General Paralysis and Tabes Dorsalis. — Dr. Henry Cotton
concludes his paper as follows:

1. Clinically tabes dorsalis and general paralysis present many
analogies in etiology, symptomatology and course.

2. Their occurrence in the same individual is more than a
coincidence.

3. In these cases of tabo-paralysis the symptoms presented are
identical with the symptoms of general paralysis and tabes when
seen apart, only differeing in degree, according to the extent of
the anatomical lesion.

4. The clinical symptoms of tabo-paralysis have the same ana-
tomical basis as in the separate diseases.

5. Anatomically the affection of the posterior columns of the
cord as seen in tabo-paralysis does not differ from the picture
presented in pure tabes. The same systems are affected and the
segmental character of the process is the same, also the process
in the cortex is identical with that of general paralysis.

6. While the above facts show the intimate relation between
general paralysis and tabes dorsalis, the unsettled status of their
pathogenesis at present prevents their identity being absolutely
established on an anatomical basis.

2. Notes of a Visit to Some Foreign Hospitals,
Mainly in Germany. — Dr. E. N. Brush says in part that the
distinguishing feature of the German clinics for mental diseases
is their resemblance to general hospitals so far as methods are
concerned. All that medical science can offer is brought to bear
in investigating the pathological conditions, both by careful syste-
matic clinical work and painstaking laboratory investigation. In
no hospital, with which the author is familiar, do patients receive
as careful clinical study as do the patients in the better known
German clinics. Admission to those clinics is accompanied by
no more difficulty than is that to a general hospital. The best
scientific men are secured as directors and internes for these
clinics, and the public has confidence in those men. The demand
for clinical instruction in psychiatry in this country is a crying
necessity, and some of us long for the day when our material in
psychiatry may be made available. Such an innovation would
be for the lasting benefit both for the insane and the physicians
who would study and treat the patients' maladies. "To confess
that that dawn seems far off, and that it is delayed by the clouds
of political ignorance and political vice which overshadow so many
other things which might work for the healing of the nation is
humiliating, but the truth compels the admission."

COMPARATIVE MEASUREMENTS OF THE HARD PALATE. 151

3. Comparative Measurements of the Hard Palate in
Normal and Feeble-Minded Individuals. A Preliminary
Report. — Drs. Walter Channing and Clark Wissler. The
measurements reported on are: A. The minimum distance be-
tween the first molars measured horizontally from the bases
of the molars. B. The maximum height of the palate,
measured from the approximate plane of the gum line. C. The
distance from the line connecting the two first molars to the
alveolar point. D. The distance between the canines, measured
horizontally from their bases. It is concluded that the absolute
size of the palate as measured by the specific dimensions seems
to be the same for feeble-minded as for normal individuals.
There is a relatively small difference in the variability of these
demensions, feeble-minded showing greater variations. The
width of the palate from the first permanent molar forward re-
mains approximately unchanged from the ninth or tenth year of
life. It is probable that there is no appreciable growth after the
sixth year.

The Cerebral Cortex of the Dolphin (Delphinus Delphis).
Histological Research.— Dr. V. Bianchi concludes his paper
as follows :

1. The research shows a striking correspondence between the
macroscopic disposition of the cerebral hemispheres, the histologi-
cal structure of the cerebral cortex and the psychic manifestations
of the dolphin. The contradiction between the richness of the
cereberal convolutions of this animal and its relative stupidity is
explained by the architecture of the cerebrum.

2. The cerebral hemispheres of the dolphin have the same char-
acteristics as those of carnivorous animals. The difference be-
tween the two consists of the lesser development of the frontal
lobes in the dolphin. The meagre frontal development in the
latter quite recalls that of microcephalic subjects.

3. The structure of the cerebral cortex differs from, that of
more intelligent mammalia, among other things, by a certain uni-
formity of its elements, scarcity of the giant pyramidal cells and
the paucity of their prolongations among the few that can be
found.

4. The relation between the cellular body and the neuroglia
reticulum is quite distinct in the dolphin, appearing either as a
pericellular, intracellular or intraprotoplasmic network.

5. Contrasting these findings with those of the cerebral cortex
of man, it may be stated that the marked psychic stupidity of the
delphinus delphis is due to the paucity of development of the
frontal lobes — the principal seat of the power of association (Prof.

152

EXAMPLE OF USEFUL WORK DURING SLEEP.

L. Bianchi), to the uniformity of the elements of the cerebral cor-
tex and the paucity of the giant pyramidal cells (Annali di Nev-
rologia, Vol. XXII, No. 6).

Example of Useful Work Daring Sleep. — P. Bovet
publishes a case of a youth who owes his success at an examina-
tion to a useful dream : he should have studied up a large number
of French works, one of which was Moliere's he Misanthrope.
All the works were gone over, except the last named. He had
never read it nor had he seen it played. He had seen, however, the
last ten verses on one page in a given edition of Moliere's works.
Before retiring, he had decided to present himself at the examina-
tion the next day without having ever read the verses. The fol-
lowing morning he woke up early and was quite astonished to find
himself reciting the verses. He then recalled that he had dreamt
of reading the same verses. At the examination he was asked
to recite the latter and he did so creditably. The author explains
the incident by the youth's unconscious remembrance of the visual
image of the last ten verses and by a true process of reflexion dur-
ing sleep. This dream emphasizes the utility of work done during
dreams {Archives de Psychologie, Nos. 15-16, 1905).

Contribution to the Study of Porencephalia. — Dr. O.

Broglio publishes a case of true, or congenital porencephalus.
During life the patient was demented, blind and had paralysis of
the lower limbs. At the autopsy it was found that the right hem-
isphere presented agenesia of the parts corresponding to the
temporal and occipital lobes, so that the entire hemisphere was re-
duced one fourth of its size. The meninges that should have
covered the absent parts penetrated into the lateral ventricle.
Besides, there was also agenesia of the whole temporal lobe of
the same hemisphere — the upper, middle and inferior convolu-
tions. There were many other anomalies in both hemispheres.
There was also cranial malformation, the porencephalic part was
lined with the arachnoid, there was communication with the lateral
ventricle, the pia mater was absent and the convolutions of /the
porencephalic area were disposed in radii. The author terms this
case as one of true porencephalia — according to Bourneville's clas-
sification {Annali di Freniatria, March, 1905).

A Disease of the Attention. — Dr. Hospital: The disease
manifests itself mostly among the emotional, impressionable, irri-
table, sensitive, neurasthenic, and the wealthy ; it1 is more preva-
lent among the higher classes of society and the indulgers than
among the masses and the workers. The affection consists of
the various "phobias" : inability to sleep or to pursue one's occu-

NEW CHEMICAL RESEARCHES IN EPILEPSY.

15:

pation, on hearing the sound of dripping water, chiming bells,
noises, etc. Any one of the special senses may be in a state of
hyperexcitation and cause the sufferer marked discomfort. The
author says that in such cases there exists an erethism of the
attention in regard to the special sound, color, light, smell, etc.,
that constitutes a disease of the attention : the sufferer is unable
to direct his attention to anything else than the particular mani-
festation that is painful to him. The dislike of one's mother-in-
law is also1 considered as a morbid manifestation due to diseased
attention (Annates medico-psychologiques, Nov.-Dec, 1904).

New Chemical Researches in Epilepsy. — Dr. Paul
Masoin has made a study of the blood and urine of epileptics.
The cerebro-spinal fluid and sweat have also been studied. While
some striking findings have been obtained, the author is conserva-
tive and does not draw any decisive conclusions from the vast
material collected experimentally. He remarks that we know
very little of the mysteries of normal assimilation and disassimila-
tion; consequently it would be hazardous to draw conclusions in
the case of similar phenomena in pathologic conditions. The most
that can be said is that chemistry should some day resolve the
question of epilepsy, as she alone can enlighten us on biologic
phenomena. For the present it can only be said that the basis of
epilepsy is a special feebleness of the nervous cells, the convulsive
tendency of which is higher than normal. The vague term pre-
disposition is applicable here (Annates Medico-Psychologiques,
May- June, 1905).

riongolian Type of Idiocy. — Prof. Kovalevsky has had
occasion to observe Tartar-idiotic children and rinds that these
subjects and the Caucasian individuals afflicted with Mongolian
idiocy present similar vivacity of manner and bright facial ex-
pression— alongside with profound idiocy. Among the causes
found in his cases were alcoholism of the father, syphilis of both
parents, moral shock of the mother during pregnancy with the
patient, fright of the mother during pregnancy with the patient.
Among the symptoms of the patients are pointed out epileptic
convulsions, eclampsia during infancy (2 out of 1 1 cases), hyper-
tophy of the lymphatic glands (8 out of 11 cases), absence of hair
on the pubes and in the axillae (7 out of 9 cases), irregular dental
implantation in 8 cases, narrow palate in 5 cases, standing out
ears in 8 -cases, squinting in 5 cases, swelling of the face (ather-
oma) in 2 cases, and monorchismus in 1 case (it is not stated in
proportion to what number of cases, but presumably they are all
in proportion to 11 cases observed by the author). (Vestnik
Doushevnich Boteznei, No. I, 1905).

154 A CASE OF SEXUAL INVERSION.

A Case of Sexual Inversion. — Drs. Antheaume and
Parrot publish the case of a sexual invert, 18 years of age. He
had attempted suicide because the world did not approve the mode
of sexual life he should have wished to lead. In a detailed letter
the patient, a well educated person, explains his psychic life from
the special point of view of his trouble. In his farewell letter,
written on the eve of his attempt on his own life, he said, in part,
that life was made tolerable for the majority of men by hope and
ambition, but that the great mass of common people, although
living in misery, clung to life because of sexual voluptuousness
that enabled them to forget their troubles. He was not ambitious
himself and did not care for women. What he cared for was dis-
approved by society. Hence, he had decided to> die (Annate
Medico-Psychologiques, No. 3, 1905).

Anatomopathological and Clinical Contribution to the
Study of the Relation of Syphilis and Progressive Paralysis.

— Dr. R. Stanziale concludes his paper as follows :

1. Of 100 cases o>f general paralysis 87 had histories of syph-
ilis. Of the 87 cases there were 70 with a positive history of
syphilis and 17 with a dubious history of the same.

2. Of the 70 positive cases there were 32 in which syphilis was
the only pathologic cause and 38 in which there were other causes
besides syphilis.

3. Syphilis may be the only cause of general paralysis, but
heredity and acquired causes often accompany the former.

4. In cases of progressive paralysis due to syphilis the lesions
of the vessels of the nervous system are of syphilitic origin.

5. Mercurial treatment does not modify the course of the dis-
ease (Annali di Nevrologia, Vol. 2, No. 4).

Decline in Birth-Rate and Mortality of Infants. — F. S.

Krum reviews the statistics of the Government statistician of
New South Wales, T. A. Coghlan, showing that a notable de-
cline has occurred in recent years in the birth-rate of New South
Wales. Other than natural causes have contributed to bring
about the rapid fall in the birth-rate No causes dependent on
natural law have contributed to this decline. The desire of a high
standard of ease, comfort and luxury seem to be the essential aims
in life of the population and to attain their wishes find it con-
venient to do away with the natural results of marriage. Within
the last fifteen years the practice of "prevention" has been the
great cause of the declining birth-rate (American Statistical Asso-
ciation, Sept.-Dec, 1904).

THE ETIOLOGIC ROLE OF SYPHILIS IN THE PSYCHOSES. 155

The Etiologic Role of Syphilis in the Psychoses. — Dr. L.

Marchand concludes from his paper that the toxin of syphilis
may bring about psychoses in the predisposed. This etiology of
psychoses is not common. The mental diseases appear almost
always during the months following the infection. Specific cuta-
neous lesions frequently Coexist with the mental manifestations.
Mental disturbances may accompany syphilis whether the latter
is of a mild or severe nature. The most frequent forms of psy-
choses are melancholia, mania, hallucinatory delirium and stupor.
These psychoses end almost always in recovery. According to
clinicians' ideas specific treatment cuts short the course of the
psychoses. Syphilis may also cause melancholia or suicidal ten-
dency through the hypochondria that syphilities are apt to have
{Revue de Psychiatrie, No. 5, 1905.)

Inheritance in flan. — Alice Pearmain reviews Karl
Pearson's work, in which it is said that mental characteristics are
as readily inherited as physical ones are. In his country, like in
America, the intellectual classes are scarcely reproducing their
own numbers, and are very far from keeping pace with the total
growth of the nation. The fertility among the intelligent working
classes is also much less than among the uneducated laborers. He
expresses his fears that "we stand by an epoch, which will be
marked by a great dearth of ability." The "remedy lies first in
getting the intellectual section of a nation to realize that intelli-
gence can be aided and trained, but that no education can create
it. It must be bred" {American Statistical Association, March,

I905)- J

The Psychical Faculties of Ants and Some Other Insects.

— A. Forel : Considering the domain of perception, will, emotion
and correlation in insects, the author concludes that all the pecu-
liarities of the human soul can be derived from the peculiarities
of the souls of the higher animals ; and all the peculiarities of the
souls of the higher animals can be derived from those of the
lower animals. Simple but convincing experiments accompany
the arguments. The doctrine of evolution, the author says, is
just as applicable in the physical field as in the other fiields of
organic life {Annual Report, Smithsonian Institute, 1903).

Nyctophobia in Children. — R. Senet has studied a num-
ber of cases of children having fear in the darkness of night. In'
the majority of cases nyctophobia in children is a collateral phobia.
In other cases it is a panophobia, the children fearing not the dark-
ness but everything that may be hidden in the darkness and prove
prejudicial to them. In treating such cases, it is well to find the

156 GENESIS AND CORRELATION OF THE NERVOUS ELEMENTS.

primitive phobia that had caused the trouble (Archives de Psychol-
ogic, Nos. 15-16, 1905).

The Genesis and Correlation of the Nervous Elements
of the Spinal Cord in the Chicken. — Dr. E. Lapegna con-
cludes his paper as follows :

1. The ganglionic cells take no part in the formation of the
nervous fibres.

2. During the first period of development, the nervous fibre has
no connection with the ganglionic cell.

3. The peripheral and central nervous fibres develop from cel-
lular chains.

4. The cellular chains form only the axis cylinder of the fibre,
but they do not contribute to the formation of the other attributes
of the fibre.

5. The fibre and the protoplasmic prolongations of nervous
cells develop from cellular chains.

6. The neurofibrils of the nervous cell are tardy products, of
differentiation. In the chicken the neurofibrils do not appear be-
fore the tenth day of hatching (Annali di Nevrologia, Vol. XXII,
No. 4).

Vambery and His Linguistic Organ.— In Volume II, page
452, of "The Story of My Struggles", the distinguished linguist,
Prof. Artemius Vambery, says, in part : "An American surgeon
asks me to send him a photograph of my tongue, that from its
formation he may draw his conclusions as to my linguistic talent".

The Weight of Prof. Taguchi's Brain. — According to the
"New York Times", September 7, 1904, the brain of the Japanese
anatomist, Prof. Taguehi, weighed 1,520 grams and stands thirti-
eth in the list of brain weights of men distinguished in the pro-
fessions, arts and science. The weight of the same brain, how-
ever, is said to be 1,920 grams, according to American Medi-
cine, December 17, 1904. The weight of the human brain ranges
between 300 grammes for the imbecile to 2,000 grammes for the
man of genius.

How Should Fatigue of School Children Be ileasured? —

M. C. Schuyten : Various methods of investigation are con-
sidered and indications given how to avoid erroneous conclusions
in esthesiometric experiments of children. The general con-
clusion is that children are more fatigued in the afternoon
than in the morning. The morning lessons are more fruitful than
are the afternoon lessons (Archives de Psychologie, November,
1904).

STUDIES OF JUVENILE GENERAL PARALYSIS. I57

Clinical and Anatomopathological Studies of Juvenile
General Paralysis. — F. Burzio: — Juvenile progressive paraly-
sis, although analogous in form to that of adults, has
its peculiar characteristics : there is frequently arrest of evolution
of puberty, predominance of somatic phenomena (tremors, epi-
leptiform attacks, apoplectiform spells) over the mental disturb-
ances (dementia with or without delirium) ; finally, the cerebral al-
terations are frequently accompanied by lesions of the medulla
oblongata and the spinal cord (Annali di Freniatria, March, 1905)

Schopenhauer inherited his mind from his mother who
was energetic, a writer and heartless; his character — from his
father, who was a banker, odd of conduct, a melancholiac and
committed suicide by shooting. Schopenhauer himself was also
a melancholiac and subject to various "phobias" : he fled from
Naples, Verona and Berlin for fear of contracting small-pox,
cholera or of being poisoned. At times he had hallucinations
of hearing (Naouchni Archiv Vilensfaoi Okrougenoi Lechebnizi,
Nos. 1-2, 1904).

Statistics of the Deaf and Dumb in Germany. — John Koren
finds that, according to the Imperial Board of Health Reports,
during the last decade there has been a perceptible decrease in
the number of the deaf and dumb. The principal cause of deaf-
mutism, aside from heredity, is unfavorable material conditions
and an unhygienic mode of life (American Statistical Associa-
tion, Sept-Dec, 1904).

Psychic Hemiplegia in a Paranoiac. — Dr. Zaregradski:
The patient was a typical paranoiac and during the period of de-
lusions of grandeiir manifested hemiplegia. A thorough ex-
amination proved the hemiplegia to be of psychic nature. The
author explains the mechanism of this manifestation by hypo-
chondriacal preoccupations of the patient and by auto-suggestion
(Vestnik Doushevnich Boleznei, No. 5, 1905).

Continuous Involuntary Crying. — Mrs. Kate Wilbourn, of
Sioux City, la., presented herself for commitment to the asylum
because she had been under a crying spell of four days' duration.
She is said to be perfectly sane, but cannot stop crying {American
Medicine, July 1, 1905).

Two Cases of Korsakoff's Psychosis are published by
Drs. Patterson and McCarthy. Anatomo-pathologic findings are
also presented, but nothing definite or characteristic has been
found in this regard (American Medicine, July 1, 1905).

158

BOOK REVIEWS.

The Role ot Dreams. — In his article on the biological theory
of sleep, Dr. Claparede says that the role of dreams is probably
that of exercising certain activities (creative imagination, etc.),
that are useful to the species, but that do not always have occa-
sion to be brought into play in the individual life.

BOOK REVIEWS.

La Psychologie des Romanciers Russes du XlX-me Siecle.

— Ossip-Lourie. i volume in-8. Felix Alcan, publishers, Paris.
Price 73^ frs. It is difficult to understand Russian literature from
reading it in translations. The depth and pathos, flexibility and
gentleness of this literature can be understood by none but those
who are thoroughly familiar with Russia, its language, its people,
customs, social structure and economic and political network.
Ossip-Lourie, the prolific philosophic writer, is thoroughly famil-
iar with all the elements that make one competent to understand
Russian literature. In this volume of some 438 pages he has
surpassed himself in the matter of philosophic analysis of Russian
literature of the XlX-th century: he presents here the colossal
works of Gogol, Tourgenief, Gontcharov, Dostoevsky, Tolstoi,
Garchine, Korolenko, Tchekhov, Gorki, etc., etc., passing the re-
spective masterpieces in review in his familiar decisive and clear
style. Although the work is written in the French
language, the subject is so vividly presented that the
reading of it leaves an impression as if it had been
perused in the Russian language itself. So far as the value
of this volume is concerned, therefore, as an exponent of a litera-
ture that most of us are not privileged to understand, — all praise
is due to its author. The practical conclusions from this analyti-
cal study, however, present the most important part of the volume.
At this moment, when the great struggle in the Far East is going
on, the whole world has become psychologically inclined and is
asking why and wherefore? In a small chapter of conclusions the
author presents not only the psychology of the nation so well
familiar to him, but also what he calls the psychiatry of the same
nation. The few remarks that follow give an idea of his trend of
thought.

The Russian writers have come from all the classes — beginning
with the highest aristocracy and ending with the lowest vaga-
bond. The ideals and national characteristics expressed in this
literature, therefore, are not narrow, descriptive of one class of

BOOK REVIEWS. 1 59

people ; on the contrary, all the classes and their ideals are fully
represented and masterfully depicted in the types of the heroes
and heroines. The most characteristic trait that first strikes in
the pictures of those types is the absence of will-power. All
the types show a lack of foresight, judgment and purpose. No
literature presents as much pathology of will-power as the Rus-
sian literature does. Volition in the personages in Russian novels
is always paralyzed, never transformed into an act. Those types
often know how to wish for things, but never how to transform
their wishes into acts. And for the reason of non-action, the wish
itself becomes enfeebled and even disappears. This condition the
author explains by the particular social life in Russia, that has
made almost no progress within the last century. The trend of
thought and social life described in War and Peace, written in
the beginning of the XlXth century, is the same as that described
at the end of the same century in Resurrection. Social movement
is nil and individuality is in a state of stagnation. The inertia that
is forced on the Russian explains perfectly, the author says, the
absence of resolute energy and proper direction of will-power of
the Russian nation. The lack of exercise of its will-power has
caused atrophy of the latter and every outburst of struggle is
followed and even accompanied by intense fatigue : there is either
apathy or exaltation, but the normal state is unknown to this
type. Orchansky is quoted as saying "a small proportion of in-
sane are within the walls of our asylums, in Russia; the great
mass of hundreds of thousands of subjects, on the contrary, with
paralyzed will-power, are at large." While capable of an auda-
cious outburst, ready to sacrifice himself for his ideas, the Rus-
sian becomes lamentably feeble whenever he is required to use
sustained effort for any length of time in order to uphold the same
ideas. The atrophy of will-power and the abundance of psychic
invalidity of the kind explained among the Russians are results
of the social structure in Russia, of its degrading regime and in-
terference with all personal liberty and individual initiative. Even
the higher classes, who have and are enjoying the advantage of
European culture, borrow the customs, manners and polish in
Europe without being touched in any way by the spirit of West-
ern civilization.

Panslavism is a chronic delirium born of the conditions men-
tioned above. It is a manifestation of megalomania. The theory
held by the panslavist is that Western civilization is rotten and
must make place for a new civilization — that must come from
Russia. This new civilization the author calls the civilization of
the Knout. The rapid strides of this new civilization, the author

l6o BOOK REVIEWS.

says, have thus far ended in the question of Poland, Finland,
Kishineff and Manchuria.

Pushing further the study of the psychology of Russia, the
author points out the results of its peculiar methods as applied
to its nation. The ignorance of the masses has borne corre-
sponding fruit. Dostoevsky makes Verchovensky say, in Bessy:
"The nation is drunk, the mothers are drunk, the children are
drunk, and in the courts of justice one continually hears 'Sen-
tenced to 200 lashes.' Let the generations grow ! What a pity
we cannot wait to see them. They shall all have become drunk."
Sikorsky, Orkhansky and other alienists are sounding the alarm
about the extensive prevalence of alcoholism and epilepsy. Orch-
ansky says : "In Europe alcohol is drunk in small glasses, but
here epidemic alcoholism affects whole communities, -'—the rulers
and the ruled drinking by the half-bottle."

And yet the vitality of the Russian is immense. Tchekhov's
hero is made to say that the Russian vitality must triumph in the
end.

This is a valuable volume written by one of the most competent
scientific writers on general literature.

Semeiotics and Diagnosis of Mental Diseases. Their
Treatment and Handling. — Serge Soukhanoff, Privat-Do-
cent, University of Moscow. M. Borisenko, publishers, Moscow.
This work appears in three parts, of 175, 180 and 206 pages each.
It represents a collection of lectures on mental diseases delivered
at the University of Moscow, in 1904. The first part is devoted
to the consideration of melancholia, mania, amentia and primary
mental confusion. The second part treats of Korsakoff's disease,
obsessional conditions and circular psychoses. The third part
deals with primary juvenile dementia, progressive general paraly-
sis and psychoses during the course of cerebral arterio-sclerosis.
The subject is treated in the most modern style, the newest scien-
tific and clinical conceptions relating to psychiatry being fully
represented. Dr. Serge Soukhanoff is well known not only in all
Western Europe, but also in this country. Some parts of the
present work were published in this Journal. His excellent study
of Korsakoff's disease, for instance, appeared in 1903, Vol. IV.,
Nos. 1, 2, and 3, of this Journal. Dr. Soukhanoff is one of the
younger psychiatrists who consider it a necessity to be familiar
with the fine anatomy of the brain in order to properly under-
stand the study of psychiatry. His erudition and special scientific
knowledge are well reflected in his present work, a translation of
which into English would constitute a fine addition to our psychi-
atric literature.

The Journal of Mental Pathology.

Vol. VII. 1905. No. 4.

REFLEX AND AUTOMATIC EXCITABILITY.

(From the Physiological Institute, University of Rome, Italy)

By Dr. Sergio Sergi.

In this brief communication I shall make some cursory remarks
on the results of some experiments made on the testudo grceca.
The results seem to me to be of general interest as regards the
function of the central nervous system.

Methods and Results. — In one of my papers (i) I
described the experimental method used. I have followed the
same method in this experimental work. I wish to remark that
the experiments were made on the semi-membranous muscle, sec-
tioned at the end of its tibial insertion, the free end connecting
with a recording lever. In the study referred to above I pointed
out that at all seasons of the year the voluntary muscular activity
of the testudo grceca presented a periodic irregular form and that
every period presented two phases : one of marked and the other
of decreased activity. Similar results have been obtained in my
new experiment to be presented below.

The tortoises were kept under experiment many hours in suc-
cession, before taking the tracings, so that the form of their indi-
vidual voluntary movements should be expressed more completely
than would have been the case otherwise. This made it possible
to draw a correct parallel between this form of movements and
that obtained by reflex action or caused by given stimuli.

A fact of constant occurrence is that even under similar condi-
tions not all animals react in the same manner, some responding
readier to stimuli than others, while some do not respond at all.

!62 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 4.

This does not imply, however, that there is a decreased volun-
tary activity ; in fact, I have observed exaggerated periodic volun-
tary motility following marked deficiency of reflex excitability.
In such a case, during the period of repose, when all excitability
is concealed, it may be said that there exists a condition of
somnolence of the central nervous system. Sometimes, single
tactile stimuli do not provoke any motor response, while repeated
tactile or dolorific stimuli are followed by a phase of great ac-
tivity that may be termed activity of awakening. This induced
phase does not present any individual characteristics differing
from those not preceded by stimuli. Hence, it expresses awaken-
ing of voluntary activity brought out through reflex channels.

Increase of the surrounding temperature causes the phases of
marked activity to come closer together, their tracings becoming
less and less marked and finally disappearing altogether; in such
cases the contractions are made more frequently but are less
ample, on the level of the tonus line that rises higher and higher.
With the lowering of the temperature the voluntary movements
decrease until they disappear altogether, although the reflex ex*
citability can still be provoked; the tonus oscillations also gradu-
ally incline towards the minimum, the most important ones follow-
ing the contractions, after which there is a gradual descent.

Quite often the muscular reaction to tactile stimulation is ex-
pressed by relaxation or contraction. Such relaxation takes place
now quickly, and is followed by a brisk return to its tonus line of
stimulation, now slowly, and is accompanied by a descent of the
tonus line that lasts a given period of time; at other times the
relaxation is followed by a contraction. Muscular relaxation
takes place mostly when the stimulus is enacted in some region of
the body opposite to that in which the muscle furnishing the trac-
ings is, or at least in one of the regions of the body outside of that
comprising the recording muscle. The stimuli causing such re-
actions are such as touching of the nates, eye-lids, neck or the
limbs, but the reactions do not present any fixed form ; indeed, the
same stimulus may cause synchronously relaxation in both semi-
membranous muscles, just as well as contraction in one and relaxa-
tion in the other muscle. These reactions are not proportionate to
the intensity of the stimulus, as marked and feeble stimuli,
respectively, such as pricking of the inner nostrils with a sharp
metallic point, may provoke either relaxation or contraction. I
have also observed active relaxations of the triceps muscle of the
anterior limb, and made some experiments with such relaxations.

It is most interesting to note the frequency with which some in-
dividuals react to a given stimulus in a given point rather by

REFLEX AND AUTOMATIC EXCITABILITY.— Dr. Sergio Sergi. 163

relaxation than by contraction, and the frequency of the occur-
rence of relaxation on the side opposite to that on which the
reacting muscle is.

If stimuli of the same nature (repeatedly touching a limb in
the same place) are made to follow at given periods during the
phase of repose, the first stimulation may be followed by a quick
contraction and rapid augmentation of the tonus, after which the
tonus descends slowly, the rapidly succeeding contractions pro-
voked by the similar contractions being registered on this line of
descent. Hence a stimulus causing a rapid contraction with rapid
increase of the tonus may, if repeated, provoke new rapid con-
traction without bringing about new changes in the tonus. Sim-
ilarly, an excitation, followed by relaxation of the tonus that
relaxes more and more with the repetition of the stimulus, causes
small and rapid contractions that are registered on the descending
tonus line.

At times I obtained the phases of activity after single stimuli
that were followed promptly by quick relaxation of the muscle,
and hence of the motor group. In one tortoise, in which the tem-
perature did not reach 17 degrees C, it was impossible to find
other forms of movements, while at 17 degrees C, periodic forms
with tonus oscillations appeared; the phases of great activity of
voluntary movements were preceded by muscular relaxations
similar to those obtained through reflex channels at a lower tem-
perature, after which the groups of movements followed.

In the experiment in which the phase of repose was represented
by a descending tonus line, the stimuli that caused muscular re-
laxation readily provoked the reaction, transforming the slowly
descending tonus line into a descending line by gradation. The
stimuli that caused muscular contraction either did not cause any
reaction or had to be repeated in order to obtain it. Hence, if the
stimulus was followed by a reaction, in the sense of automatic
tonus oscillation, the response was obtained much quicker and
easier than when the stimulus acted in the antagonistic sense.

Another important observation is the following : a tactile stimu-
lus was repeated many times during a long time with the same
rapidity and intensity (repeatedly and rapidly touching the
posterior limb on the side opposite to that of the recording mus-
cle) ; this excitation was kept up during the entire length of the
period including both the phase of repose and that of great activ-
ity. The stimulations were started at the beginning of the period
of repose (see Fig. 1). These were followed by continuous con-
tractions, the amplitude of which did not reach even half of that
of the voluntary groups. These induced contractions were dis-

i64 JOURNAL OF MENTAL PATHOLOGY. Vol. VIL, No. 4.

posed on the descending tonus line, whereas in the part of the
tracings obtained before the infliction of the stimulus, during
the phase of repose, there was no such form of tonus oscillation
(see lower tracing of Fig. 1). During the excitations the groups
of contractions are ampler than those that precede, and corre-
spond to the group of movements of the phase of great activity
or the awakening of the animal. This group of ample contrac-
tions was followed by another group of shorter ones registered
on the tonus line corresponding to the maximum elevation ob-
tained during the phase that preceded. The tonus oscillated
slightly, gradually descending, finally to join the level of the
maximum contractions during the first stimulations ; after this the
tonus, descending slowly, returns to the line it presented pre-
viously— during the voluntary movements. This tracing demon-
strates the influence of movements on the tonus, and that under
the action of a given and continuous stimulation it is possible to
transform, through a reflex channel, the phases oi repose and
activity.

Soon after this experiment, when the phase of the repose had
already begun, I repeated the same stimuli on the same animal.
In the tracings (see Fig. 2) two alternating phases can be dis-
tinguished during the entire period of the stimulation : one,
ampler and more distant, and one of shorter and closer contrac-
tions— both oscillating about the high tonus line, but the second
much more so than the first one; the latter represents the phase
of great activity, while the former that of small activity modified
under the action of continuous stimuli. When the stimulation
is suspended after this long activity there is compensatory repose.

Lowering the temperature, while the voluntary movements are
dying away and reflex excitability is retained, it may be seen that
the action of prolonged stimulation does not cause the forms de-
scribed above, but there are rapid and uniform, ascending and
descending movements about the tonus line.

Conclusions. — The excitability of the central nervous sys-
tem is not the same during voluntary and reflex action respec-
tively. Indeed, there may be marked voluntary activity, while
reflex activity is totally wanting. On the other hand, all volun-
tary manifestation may be dormant, while reflex action can be ob-
tained with the greatest ease. There exists, therefore, automatic
excitability for the display of voluntary activity that is distinct
from reflex excitability.

Lowering of the temperature depresses both activities, and
heightening it within certain limits awakens both, but the reflex

REFLEX AND AUTOMATIC EXCITABILITY.— Dr. Sergio Sergi. 165

is more resistant than is the automatic excitability to changes of
the temperature.

The automatic excitability may be whipped up by stimuli;
hence, a preceding reflex excitation may cause or influence the
conditions necessary for the awakening of the voluntary groups.
During the display of voluntary actions, that are exponents of
automatic excitability, the reflex excitability is at its minimum.
On the contrary, during the phases of repose reflex excitability
is at its maximum. Hence, automatic excitability does not go
hand in hand with reflex excitability, but tends to suppress it.
Indeed, rhythmically repeated stimuli modify the phase of activity
much less than does repose.

Automatic and reflex excitability do not act similarly in relation
to the tonus and the rapid contractions: the tonus is influenced
more by reflex excitability, while the rapid contractions are more
influenced by automatic excitability, so that during the phase of
great activity the reflex action appears through the modifications
of the tonus line and not through those of rapid contraction. This
fact is still more accentuated when the rapid contractions are
caused by reflex action.

The automatic excitability is refractory to a certain extent to
the influence of reflex action not only as regards rapid contrac-
tions but also as regards the tonus ; this appears when stimuli
tend to modify, in an antagonistic sense, the automatic mani-
festations of the tonus, while there is the contrary effect when
these stimuli are directed to favor the automatic manifestation.
Another example of the refractoriness of the tonus oscillations
I described when speaking of rapid stimuli at a certain distance,
that do not succeed in modifying the tonus line brought about
through reflex channels, but that cause, on the contrary, new
rapid reflex contractions.

The facts described amply demonstrate Fano's claim (2) made
a few years ago, the essence of which is about as follows :

"A centre may be excitable through automatic stimuli that
reach it through the intercellular connections and not through an
excitation reaching it from the periphery." Fano arrived at this
conclusion from experiments made on the emis europcea scere-
brata, in which he could observe the prevalence of automatic
movements in the anterior limbs and of reflex movements in the
posterior ones. In the testudo grceca I observed similar facts and
shall consider them in another paper devoted to the analysis of
associate movements in this animal. My present study also
demonstrates that both rapid and slow contractions (tonus os-

!66 JOURNAL OF MENTAL PATHOLOGY. Vol. VIL, No. 4.

dilation) are differently influenced by automatic and reflex
actions respectively.

REFERENCES.

(1). Sergio Sergi. — Sull'attivita musculare volontaria nella
tesiudo grceca, Arch, di farmacologia sperimentale e sciense
aMni, Vol. IV, 1905, Roma.

(2). Fano. — Saggio sperimentale sul meccanismo dei movi-
menti volontari nelle testuggine palustre. R. Istituto di Studi
Superiori di Firenze, 1884.

EXPLANATION OF THE TRACINGS.

Fig. I. Tracings of the semi-membranous muscle of the test-
udo grcEca while in normal relation with the central nervous sys-
tem.

The lower tracing shows the phases of small and great activity
during the development of the voluntary movements. The upper
tracing shows the modification of the same phases in the same
individual under the influence of a rhythmic tactile stimulus: in
1, the stimulus commences, in 2 it ceases. The more ample con-
tractions, in the middle of the experiment, after which the tonus
line keeps up quite high, correspond to the phase of great activity,
this activity being more evident on the lower line of the tracings.
In * the stimulation is suspended for a very short time.

Fig. 2. Conditions as in Figure I.

In 3 the stimulations commence and in 4 they cease. The
phases with the more ample contractions of the upper tracing cor-
respond with those of great activity, the tracings of which are
more clearly seen on the lower line obtained on the same animal.

JOURNAL OF MENTAL PAT HOLOGY. Vol. VII., No. 4. Dr. Sergio Sergi.

NEURASTHENIA AND NEURO-HYPERSTHENIA

OF GROCCO.

A CRITICAL REVIEW.

By Dr. Pietro Timpano?

Professor Grocco, of the Superior Institute of Florence, re-
marks in the Bollettino delle cliniche, February, 1905, that cer-
tain authors confound certain neurasthenic syndromes with neu-
rasthenia itself, while those syndromes are in reality physio-path-
ologic manifestations of an entirely different affection. Thus,
while neurasthenia is a disease characterized by functional ex-
haustion of the nervous system, the symptoms described by
Grocco are characterized by prolonged functional exaltation of
one or more spheres of the nervous system itself.

Importance is claimed for this distinction both from the theo-
retical and practical points of view, as the treatment of the
hypersthenic differs from that of the neurasthenic subject.

I shall consider below whether the syndrome described by the
eminent clinician of Florence, and designated by him as neuro-
hypersthenia may be considered as a pathological entity and
whether it may be brought into the large group of neurasthenias.

A cerebral excitation (an idea or group of dominant ideas)
may cause, in a manner similar to that of an internal cause, exal-
tation of psychic activity for a more or less long period of time.
The patient then becomes excited, his mimic emotiveness is ex-
aggerated and the various manifestations of speech are also
exalted. Nervous tension is exaggerated in the cerebral sphere
and hypersthenia becomes manifest. According to Professor
Grocco, these manifestations have nothing in common with neu-
rasthenia in which nervous tension is decreased.

168 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 4.

There may be cerebral excitation without exaltation, as is the
case when one is preoccupied without being depressed. Under
such conditions the nervous tension is also high and the state
corresponds to hypersthenia. The only difference between the
two excitations lies in their respective colorings, tonus of senti-
ment and, according to Grocco, both conditions represent a neuro-
hypersthenic syndrome.

Prolonged excitation and hyperfunction are always readily
obtained. Thus, increased gastro-intestinal activity as regards
secretion, rapid digestion and ready defecation ending with de-
ranged gastro-intestinal function would be one of the examples
of neuro-hypersthenia. Considered in themselves, such syn-
dromes may be said to represent morbid entities differing from
neurasthenia, and hence their clinical value would also be dif-
ferent. The prognosis and treatment would also be different.

But is there really an essential difference between the path-
ologic conditions that Grocco brings under the heading of neuro-
hypersthenia and neurasthenia properly speaking? It seems to
me that the distinction is more theoretic than real. Indeed, what
is the characteristic feature of neurasthenia? Grocco himself
defines neurasthenia as an exhaustive disease of the nervous sys-
tem. Now, the nervous system or given parts of it may become
exhausted in two principal ways: slowly, — when the causes act
gradually (chronic intoxications, infections, slow and repeated
emotions, sexual abuse, etc.), finally reducing the vigor of the
nervous system so that in the end all the organs are in a condition
of exhaustion at the slightest attempt at function; rapidly, —
when an acute intoxication or infection or a violent emotion pro-
foundly disturb the cerebral or spinal functions, particularly
when there is hereditary or acquired predisposition, the nervous
tissue becoming so changed that the processes of integration and
disintegration are altered, or integration is slow while disinte-
gration is accomplished more rapidly. Such a condition brings
about debility of the tissues and their abnormal exhaustion dur-
ing function.

Under the conditions just described the nervous system may
be whipped up, during a given period of time, and brought into
a condition of functional exaltation, without there being any
manifestations of exhaustion for a given time. This may be fol-
lowed by two conditions : either the more or less prolonged hyper-
function is followed by a cure or else the final condition of nerv-
ous exhaustion becomes more marked and persistent.

Should not the induced hypersthenia come under the heading
of neurasthenia? The condition is different, but the disease re-

NEURASTHENIA AND NEUROHYPERSTHENIA.— Dr. Timpano. 169

mains the same. If the nervous system responds to a stimulus
by entering into hyperfunction of marked duration, it means that
it is highly excitable because of its condition of exhaustion. If
the induced hyperactivity is slight and of short duration, the
subsequent exhaustion may be of no importance; in the con-
trary case, however, the subsequent exhaustion may become
troublesome.

Whether the nervous system reacts to the stimulus by exalta-
tion or morbid exhaustion, the root of the evil is always its de-
bility, a slight excitation bringing out exaltation of a certain
duration and frequent repetition of the same only causes eventual
nervous debility more marked than it was originally. Hence,
neuro-hypersthenia is the effect of a special debility of the nerv-
ous system, just as neurasthenia is the effect of a deeper and more
marked debility.

In order to draw a still finer distinction between neurohyper-
sthenia and neurasthenia, Grocco states that in the treatment of
the respective diseases excitant medication agrees with the neu-
rasthenic while it is contraindicated in hypersthenia. This point
of view is not verified, however, in clinical work. One need only
call to mind the treatment of the various disturbances of sexual
function as regards, say, erection and ejaculation to see that
Grocco's assertion is not sustained clinically: consider, for in-
stance, the administration of strychnine for the purpose of rem-
edying the debilitated function of the centre of ejaculation in
the neurasthenic, — a centre easily excited and already debilitated.
Far from needing excitation, such a centre is in need, on the
contrary, of rest — all excitant agents in their various forms being
decidedly harmful. In easily provoked pollutions of the neuras-
thenic the bromides, belladonna and other calmants are indicated
rather than strychnine. The trouble in question is accompanied
and is due to functional hyperexcitability of one of the spinal
centres. And this hyperexcitability is a variety of sexual neu-
rasthenia, not a distinct entity, — not a neuro-hypersthenia in
Grocco's sense.

In some forms of cerebral neurasthenia with morbid hyperfunc-
tion characterized by ready associative and dissociative ideation,
exaltation of the various mental processes, enfeebled reflective
and critical power, etc., excitant treatment is certainly not the
proper one. Nervous excitants, traveling, etc., do harm to the
patient because they increase his abnormal nervous tension. On
the contrary, isolation, rest, psychotherapy, calmants and good
nutrition give good results. Yet the above mentioned forms may
certainly be considered as various manifestations of neurasthenia.

170 JOURNAL OF MENTAL PATHOLOGY. Vol. VIL, No. 4.

Hypersthenic conditions do exist, without any doubt, but they
differ from asthenia only in so far as the term is concerned,
otherwise Grocco's definition of the respective conditions would
have to be accepted: neurasthenia indicating a condition charac-
terized by functional exhaustion — if neuro-hypersthenia indicates
a condition of morbid functional exaltation. Such a distinction
by terms, however, does not always indicate the essential dif-
ference between the two conditions. Indeed, the conditions of
hypersthenia are generally the initial phases of neurasthenia, be-
cause, as I pointed out above, the roots of the two disturbances
are identical as regards quality, differing only as regards quan-
tity : the nature of the disturbance shapes the disease and its vari-
ous manifestations, — the syndromes. It is not correct, however,
to fashion a complete morbid entity out of syndromes forming
part of a well defined disease.

Thus, even the therapeutic considerations presented by Grocco
do not justify his terminology.

Without confounding asthenic with hypersthenic conditions,
I consider both as different clinical manifestations of one and
the same disease, applying excitant or calmant therapeutic meas-
ures according to requirements. If we made a distinction be-
tween neurasthenia and neuro-hypersthenia, the treatment and
prognosis in the respective cases would often be erroneous : if
we accepted Grocco's definition of neuro-hypersthenia as a con-
dition entirely different from neurasthenia (augmentation of
nervous tension in the former and depression in the latter) with-
out regard to the genesis and development of the respective dis-
turbances, we should end by confounding cause and effect in
the given affections. It can only be repeated that both the condi-
tions of neurasthenia and neuro-hypersthenia are the effects of the
same cause : debility of the nervous system, presenting either one
or the other phase, according to the quantity of its enfeeblement.

It is well known that neuro-psychic predisposition influences
individual reactions to morbigenous excitations. Thus, some
individuals have a more resistant nervous system than others, and
morbid excitation in some may end in recovery, while in others,
the disturbance may end in chronic nervous exhaustion. It may
be well to remark that in some cases the period of acute exalta-
tion may, instead of ending in recovery, end in a condition of
chronic nervous exhaustion — not because the exaltation has tired
the nervous tissue, but because new pathologic causes (psychic
or other) have intervened before recovery had taken place, caus-
ing lack of nervous force to sustain a normal amount of function.
In other cases, again, the new psychic disturbance may be neu-

NEURASTHENIA AND NEUROHYPERSTHENIA.— Dr. Timpano. 171

tralized, so to speak, by still another psychic cause, enabling the
subject to be dominated by the original excitation. In such a
case, the period of excitation may be called that of neuro-hyper-
sthenia, while that of depression — a condition of neurasthenia.
It is always understood, however, that we are dealing funda-
mentally with neurasthenia — whether there are periods of exal-
tation or depression.

From what has been said above the following conclusions may
be drawn:

1. The difference between neurasthenia and the syndrome of
Grocco is not that of nature but of degree, as the cause of neuras-
thenia and neuro-hypersthenia is the same, consisting of en-
feeblement of the nervous tissue.

2. The therapeutic test indicated by Grocco is not sufficient to
prove the difference between the two morbid conditions, because
it is not true that the neurasthenic can always be benefited by
excitant remedies.

3. Some phases of neurasthenia may present themselves with-
out the characteristics of profound functional depression, in which
the depression, under the influence of morbid stimulation, may
be replaced by exaltation of more or less marked duration. This
condition of exaltation, far from representing neuro-hypersthenia
of Grocco, enters decidedly under the heading of neurasthenia.

Bova, Reggio Calabria.

ELECTRIC SLEEP. AN EXPERIMENTAL STUDY
WITH AN ELECTRIC CURRENT OF
LOW TENSION. ILLUSTRATED
WITH CARDIAC AND RESPI-
RATORY TRACINGS.*

A PRELIMINARY COMMUNICATION.

By Louise G. Robinovttch, B. es L., M.D., Member, New York
Academy of Medicine, Member, American Medical Asso-
ciation, Foreign Associate Member, Medico-Psycho-
logical Society, Paris.

In Vol. VII, No. 2, of The Journal of Mental Pathology, I
explained in my paper entitled "Electrocution. An Experimental
Study with an Electric Current of Low Tension," etc., the mech-
anism for the application of Prof. Leduc's current for the purpose
of experimental electrocution. The same conditions of the nature
of the current and mode of application of the electrodes apply to
the induction of electric sleep, but the potential should be about
65 per cent, smaller. I have used various interrupters for this
purpose, and much may be said about the kind of interrupter that
is to be preferred in this experiment ; I hope to consider this detail,
however, at some future time. When the circuit is completed and
ready for use the following conditions should prevail: 110 inter-
ruptions per second, the animal receiving about $y2 volts, under
1.3 milliamperes, the current thus passing one-tenth of the entire
period.

* Experiment demonstrated at the V-th International Congress of Psy-
chology, held in Rome, Italy, April 26-30, 1005.

ELECTRIC SLEEP. AN EXPERIMENTAL STUDY, ETC.— Dr. Robinovitch. 173

Before putting the animal (rabbit for the above conditions) in
the circuit, it is wise to first interpose an inert resistance and
examine every detail before the animal is subjected to the effect
of the current. This small precaution is always valuable, often
obviating many an inconvenience consequent on some little tech-
nical defect in the circuit. Another convenience is the interposi-
tion of a mercury switch of simple construction, making it possible
for the operator to turn off the current without loss of time.

The animal is prepared as indicated in my prior paper, care
being exercised that the regions are well shaven at the contact
points and the electrodes being maintained at a proper moisture
with a saline solution. The cathode is then applied to the fore-
head and the anode to the abdomen. If sleep is maintained for
some length of time the resistance becomes lessened, and the
operator should reduce the potential according to requirements.

There are two ways of inducing electric sleep: by abruptly
turning on the required potential at once, or by slowly turning on
the current, beginning with a minimum potential and increasing it
gradually. I prefer the slow method, because it is always neces-
sary to regulate the potential, whether the abrupt or progressive
method is used and because there are motor disturbances in both
instances, the animal "falling asleep" only when the required
potential is turned on — after regulation of a too high or too low
potential.

The preliminary contractions seem to be painless, because the
animal does not cry out, as it does under other circumstances, of
which I shall treat at some future time. There is always some
motor and respiratory perturbance at the moment of closure of
the current : the animal falls on its side, stops breathing and con-
vulses. The breathing is soon resumed, but the contractions keep
up until the proper conditions are fulfilled, as already explained.
The hind limbs are the first to stop convulsing, and the fore limbs
may sometimes continue to show fine tremors during the entire
course of the experiment. Technical imperfections are often re-
sponsible for this disturbance.

General and special sensibility and consciousness are abolished
in the order mentioned. When fully under the influence of the
current, the animal may be picked up by a fold of its skin, turned
from side to side, pinched or pricked without provoking any re-
action on its part. Hearing and sight are abolished, and the eye-
balls are turned outward (*). The condition of the pupils is yet

* Dr. Z. Treves. Observations sur les mouvements de l'oeil chez les
animaux durant la narcose, Arch. Italiennes de Biologie, Vol. XXIII, N. 3,
190S.

174 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 4.

to be studied. The animal remains limp and senseless so long as
the current is kept up, sleep being immediately interrupted by
the opening of the circuit. Once awake, the animal shows no
untoward symptoms. I have records of a large number of these
experiments made in Professor Leduc's laboratory, but in none
have I observed any objectionable manifestations. In some in-
stances I subjected the same animal to the experiment several
times during the same day, maintaining the current for from
twenty minutes to one-half hour without causing the animal any
apparent discomfort or fatigue. Professor Leduc, Professor
Rouxeau and myself subjected one animal to electric sleep during
a period of three hours and ten minutes, without having caused it.
any discomfort. Prof. Leduc has himself performed the experi-
ment on dogs over one hundred times and on rabbits a good many
times, obtaining good results in all the cases. He has studied the
current in its various phases, and cautions against its application
for the purpose in question with a lower frequency of interrup-
tions. A higher frequency is also useless. While handling various
interrupters in this work, I had occasion to verify these statements.
This peculiar condition, easy to grasp on mathematical grounds,
is as yet to be explained from the physiological point of view.
Pending such an explanation, an important field for study of
cerebral function seems to be opened by these facts.

Cardiac Beats and Respiration.— The tracings of the cardiac
beats and respiration of the animal during this sleep were ob-
tained with Prof. Rouxeau's apparatus. The tracings show that
the cardiac beats and respiration are regular throughout the
course of the experiment (only a small portion of the tracings
is published with this paper). It need hardly be mentioned that
the animal remained free from all restraint during sleep.

We obtained tracings some forty-eight meters in length during
the time of the experiment. The specimen of the tracings shown
in this paper is not as perfect as are some parts of the tracings.
Unfortunately, the better tracings were obtained in the form of
extremely close registration that does not lend itself to< reproduc-
tion. The specimen published with this paper, however, gives a
clear idea of the regularity of the cardiac beats and respiration
during this sleep.

Effect on Man. — Prof. Leduc submitted himself to the ex-
periment, and the description he gives of his sensations during
this sleep is cited below in part.

"Although disagreeable, one can readily stand the sensation

ELECTRIC SLEEP. AN EXPERIMENTAL STUDY, ETC.— Dr. Robinovitch. ^5

produced by the excitation of the superficial nerves, as this
sensation gradually dies away in the same manner as does the
sensation produced by a continuous current: after reaching its
maximum, the disagreeable sensation commences to wane, al-
though the potential is still increasing. The face is red, and slight
contractions are visible upon it, as well as on the neck and even
the forearms ; there are also some fibrillary twitchings, and ting-
ling sensations extend to the hands and tips of the fingers as well
as to the feet .and toes. As regards cerebral inhibition, the centre
of speech is first to be afTected, then the motor centres become
completely inhibited. There is impossibility of reaction even to the
most painful excitations. At this stage it becomes impossible to
communicate with the experimentor. Without being in a condi-
tion of complete resolution the limbs present no rigidity. Some
groans are emittted, but not on account of any pain; excitation
of the laryngeal muscles seems to cause the sound. The pulse
remains unaltered, but respiration is somewhat disturbed. The
current was gradually increased to 35 volts, and its intensity in
the interrupted circuit was 4 milliamperes. When the maximum
of the current was turned on I could still hear, as if in a dream,
what was being said by those near me. I was conscious of my
powerlessness to communicate with my colleagues. I still re-
tained consciousness of contact, pinching and pricking in the fore-
arm, but the sensations were stunted, like those in a limb that is
"asleep." The most painful impression was that of following
the gradual dissociation and successive disappearance of the
faculties. This impression was similar to that experienced in a
nightmare, in which one feels powerless to cry out for help or to
run away when facing great danger."

Prof. Leduc regrets very much that his colleagues did not in-
crease the current sufficiently for complete suppression of sensi-
bility and inhibition of consciousness. The experiment was per-
formed twice, lasting twenty minutes each time. In both instances
awakening was spontaneous, without there being any untoward
feelings. On the contrary, he had a feeling of well-being (*).

As the experiment on Prof. Leduc was not complete, it may be
of interest to remark that anesthesia is absolute when a current of
sufficient potential is used. I experienced myself complete anes-
thesia of the forearm, hand and fingers from a local application on
the forearm of this current, 25 volts being used. The sensation
of tingling in the limb was very much like that described by Prof.
Leduc. I shut my eyes, and he touched my hand, pinched and

* Arch, d'EUctricite Medicate, July 15, 1903.

iy^ JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 4.

pricked it without my being at all conscious of what he was doing.
Anesthesia was complete.

This method seems to open a vast field for the study of cerebral
function.

I presented the experiment on rabbits at the Vth International
Congress of Psychology, held in Rome, Italy, April 26-30, 1905,
and had occasion to make some comparative observations as re-
gards the effect of this current. While I am not prepared to make
any positive assertions, it may be of interest to note that I found
the rabbits in Rome far more susceptible to this operation than
were those in Nantes, France, a smaller potential being necessary
to produce sleep in the former. Generally speaking, young rabbits
are far more susceptible to the operation than are old ones. The
influence of size among animals of the same species may be said
to be nil as compared with age. Thus, a young rabbit, twice the
size of an older one was put to sleep with about two-thirds of the
current required for the older animal, and besides, the younger
one showed much deeper cerebral inhibition. Climatic and other
conditions are probably responsible for the marked susceptibility
of the rabbits of Southern Europe.

Explanation of the Tracings.

The current presents the following characteristics: 5^ volts,
1.3 milliamperes, no interruptions per second and period i/io.

The animal is free, without any restraint, lying on its side.

The Cardiograph (Prof. Rouxeau's model) was applied as soon
as inhibition of voluntary motility was obtained.

The tracing expresses both the cardiac beats and respiratory
movements. It shows that during electric sleep both the cardiac
and respiratory rhythms remain pretty nearly similar to those
found during the normal state, with the exception that the ampli-
tude of the respiration is more marked and particularly masks the
cardiac beats (compare with tracings taken on the same animal
some time after the experiment).

The state of inhibition of voluntary motility obtained by the
passage of the current was maintained during a period of 3 hours
and 10 minutes, the current being discontinued after an accidental
loosening of one of the conducting wires. Some of the imper-
fections seen in the tracings were due, no doubt, to the imperfect
fixation of the wires (only a sample of the tracings is published
here, the entire registration comprising some forty-eight meters
in length).

JOURNAL OF MENTAL PATHOLOGY, Vol. VII., No. 4. I>R. RobinoVitch.

From the Physiological Laboratory, School of Medicine, Nantes.

Trace No. 1 shows the normal cardiac beats and respiration.

Trace No. 2 shows the cardiac beats and respiration during "electric
sleep."

The range of registration is closer in No. 2, as is indicated by the
time registration.

ELECTRIC SLEEP. AN EXPERIMENTAL STUDY, ETC.— Dr. Robinovitch. ijj

I take this opportunity to express my thanks to Professors
Leduc and Rouxeau for their kindness in having made it possible
for me to prepare the material presented in part in this paper. I
also express my deep appreciation of the kindness shown me in
Rome, in the matter of gathering the necessary instruments for
presenting the experiment at the Congress. Some of those who
directly helped me make the collection of the instruments were:
Prof. M. Ascoli, of the Scitola d'Appl. per gli Ingegnieri, and his
assistant, Privat-Docent, Dr. Ricardo Manzetti. Prof. Luigi
Luciani, and his assistant, Privat-Docent, Dr. Ducceschi; Prof.
Mingazzini and Prof. Sante De Sanctis.

To Dr. Manzetti I am especially indebted for his personal as-
sistance rendered both in testing the instruments and in demon-
strating the experiment.

I also owe a debt of gratitude to the German firm of Reiniger,
Gebbert and Schall, of Erlangen, Germany, who, at their own ex-
pense, shipped to Rome the instruments I needed, but which the
railroad strike in Italy last April prevented from reaching me
before the end of the Congress.

The Journal of Mental Pathology.

Edited by Louise G. Robinovitch, B. es L., M.D.

Vol. VII. 1905. No. 4.

STATE PRESS, Publishers,
New York.

MSS. and Communications should be addressed to the Editor,
28 West 126th Street, New York.

Address bulky mail matter to P. O. Box 1023, New York.

This Journal is published bi-monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.

Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope.

SIGN OF CIVILIZATION.

The ancient peoples attached little importance to life, as- the
latter was considered to consist of two elements constantly at war
with each other — the body and the soul. The soul was considered
the worthier of the two elements, whereas the body was looked
upon as the source of all earthly ills. Buddha concluded from his
observations of life that "from head to foot man was born of filth
and eliminated from his body nothing but filth." This point of
view led him to put the question : "where is the man, who, having
learned all this, does not consider his own body harmful to him-
self?" According to this philosophy, death and suicide did not
shorten life but only helped the soul to migrate into a better
world. Buddha's followers and many other philosophers held
similar views, and the ancient peoples who followed these teach-
ings not only became fearless of death, but looked on suicide as
an act of courage, valor and duty. This point of view, no doubt,
made it possible for the Dervishes to calmly commit suicide by
crushing their own skulls, for the Fakirs cheerfully to hang them-
selves, and the Chinese and the Japanese to> sing cheerfully while
drowning in boats they purposely caused to founder. The birth
of children must have been considered as a divine punishment,

EDITORIAL. 179

for among the Celts and Gauls it was the custom to signalize the
birth of a child by assuming mourning, singing dirges and prac-
ticing various lugubrious rites. In the period of our own civiliza-
tion we seem to take the other extreme : we mourn not the birth,
but the non-birth of babies, if a paragraph appearing in the New
York Times, on November 20, 1905, is to be taken seriously. Ac-
cording to this authority, the Rev. Francis H. Sinclair, of St.
Peter's and St. Paul's Roman Catholic Church, Rochester, N. Y.,
had the baptismal fonts in his church draped in mourning, as a
protest against the dearth of births in his parish, no infant having
been presented for baptism for six weeks.

A PROSPECTIVE LESSON IN PRACTICAL PSYCHOLOGY.

Remarking editorially on the proclamation of the manifesto
in Russia, October 17, 1905, Medmnskoje Obozrenie, No. 18,
1905, says, in part :

"Inviolability of person and freedom of speech are at last
realized in our dear Fatherland, and despotic power, from which
Russia has suffered so much, has finally seen its last day. Honor,
glory and deep gratitude to those who have made us their debtors
for this day ! Many among them were physicians !"

Honor, glory and deep gratitude, indeed, to all in general and
to the physicians in particular, for the above blessings in per-
spective. But the physicians' task is as yet not finished. Great
as the present achievement is, he has before him a much greater
achievement to attain, — that of teaching the peasant and the Cos-
sack the meaning of the blessings promised in the manifesto, and
above all — that wholesale slaughter of defenseless and innocent
people is not the proper expression of gratitude for prospective
inviolability of person and freedom of speech.

Honor, glory and gratitude is due to the psychiatrist for hav-
ing taught and for still teaching how to thwart the evil deeds of
the homicidal imbecile, while maintaining the inviolability of per-
son of his brother imbecile. But greater honor, glory and deep
gratitude awaits the Russian physician who will go right ahead
teaching the precious right to inviolability of person and freedom
of speech regardless of nationality or creed among the so-called
sane people.

SHOCKED BY 13,500 VOLTS AND LIVES.

Frederick Hendershot, 26 years old, of East Orange, N. J.,,
is said to have been shocked by an electric current of 13,500 volts
while engaged in the attempt to turn on the current at the Public

igo EDITORIAL.

Service Corporation's power house with his bare hand. The
shock turned him completely around and caused him to fall, his
head striking the switch. His fellow workingmen found him
lying unconscious. He was revived and taken to the Newark
City Hospital, in a critical condition.

Under the above circumstance it is impossible to know how long
the current had passed through the man's body. Besides, if the
man dies eventually, an autopsy alone can determine whether or
not the fall caused a serious enough trauma of the head to cause
death. Without any complications, survival after receiving a
shock from the passage of 13,500 volts through the human body is
of great interest in itself.

THE CAUSE OF COLLECTIVE HOMICIDE.

Buddhism, Confucianism et aL, are not on trial. Heed not the
wholesale human slaughters caused by the respective religionists.
Mohammedism is not on trial. Heed not the slaughter of Ar-
menians and others. Christianity "is not on trial" (Mr. George
Dobsevage, in New York Times, Nov. 13, 1905). Heed not the
wholesale slaughter of the Jews far surpassing in enormity to-
day all other slaughters known in history. No, religion is not on
trial. It is poor human nature that is on trial, regardless of its
religious garb.

THE COST OF IMPERIAL DIFFERENCES.

According to a statement made by the Japanese Minister of
War at Tokio, Nov. 12, Japan had, at one time during the course
of the Russo-Japanese war, 1,200,000 troops under arms. Of this
number 70,000 died and 310,000 were wounded or became ill ; only
15,000 died from sickness and 9,800 from wounds after coming
under treatment.

Russia's official statement of the number of her dead and
wounded is as yet to be learned.

THE CORRECT WEIGHT OF PROF. TAGUCHI'S BRAIN.

In Vol. VII, No. 3, p. 156, of this Journal, it was stated that
Prof. Taguchi's brain weighed 1,520 grams, according to informa-
tion of one publication, but that according to another publication
the weight was 1,920 grams. The correct weight is the first —
1,520 grams, as stated in Science, Vol. XX, p. 215, and American
Anthropologist, Vol. VI, pp. 577-578, 1904.

We are indebted to Dr. E. A. Spitzka for calling our attention
to this fact.

TRANSLATIONS AND ABSTRACTS OF CURRENT

LITERATURE.

An Area of Endemic Goitre in the Philippine Islands. — Dr.

Louis C. Duncan: goitre is generally endemic in mountainous
regions. In North America there are goitre areas in the hilly
regions about Lake Superior, in the Black Hills of Dakota and on
the Plateau of Mexico. In Europe, cretinism and goitre areas are
common in Switzerland, the Tyrol, Valois and other high regions
of the Alps and their outlying ridges. In Asia, goitre is endemic
in the Himalayan and other elevated regions, and in South Amer-
ica, in the Andean backbone of the continent. A recent medical
traveler in Abyssinia saw many cases of goitre on the plateaus
over 4,000 feet high, but none in the lowlands. The author has
seen endemic goitre in one of the regions of the lowlands in the
Philippine Islands — in the Municipality of Macabebe. The Muni-
cipality of Macabebe is situated on the northeast shore of Manila
Bay and occupies the delta of the Rio Grande de la Pampanga,
the second largest river in Luzon. This delta, some 10 by 12
miles in extent, is but a few feet above the sea-level and cut into
innumerable islands by a veritable network of streams, the mouths
and submouths of the river, that, on nearing the bay, branches out
like a tree. The entire area is so low that the streams are subject
to tidal flow, and the lands may be irrigated at any time of the
year. In time of high water the whole country is afloat, only the
higher dykes and the stilted houses appearing above the surface
of a vast lake. Even at the end of the rainy season the delta ap-
pears much like a flooded American river bottom. The soil is ex-
ceedingly rich, fruits grow in profusion, and two or more crops of
rice are raised in a year. The Macabebes form a tribe of about
25,000 people, small as compared with the million and one-half of
Tagalos or the eight million persons of the whole archipelago.
They occupy a single municipality, corresponding to a township
in the United States. There are no separate farmhouses, but all
the houses of a given village form one long, winding street for a
half a mile to a mile, following the course of the stream. The
worst feature of the country is the lack of potable water. A well
sunk a few feet at any place will strike water, but it is salty and
undrinkable. The inhabitants are dependent on the streams, and
fresh water can only be obtained from them when the tide is low-
est, and even then it probably contains some salt. These streams
are the sewers of the many towns on their banks, as well as the
source of water supply. The water is muddy and foul. Standing
by a stream one sees a native filling a vessel with water for drink-

!82 THE SENSE OF PAIN.

ing and cooking, while a few yards away another is emptying
refuse and excreta into the same current, which now and then
bears slowly by the inflated body of a dead pig or dog. Cholera
and smallpox are prevalent among the Macabebes, not less than
three-fourths of the adults bearing marks of the disease, and an
excessive number are blind in one or both eyes. The most notice-
able disfigurment, however, is goitre. On the street, at church, in
the homes, everywhere one sees women with enlarged thyroids.
Often two are seen in one family. The author counted nine during
a short walk on the street. Occasionally a man is seen with goitre.
The author says he did not see any case of cretinism or exophthal-
mic goitre. The tumors are not usually large, but are the more
noticeable because a tumor of any description is seldom seen in the
Philippine Islands. The author has not seen any other areas of
endemic goitre, but says that they may possibly exist. Roughly
estimated, the proportion of subjects with goitre is given as 20 per
1,000 of the population. The author is the first to call attention
to the existence of endemic goitre in flatlands, although it is said
that there are goitre areas in the flat, marshy regions of Western
Russia. It is supposed that the active agent producing goitre,
whether chemical or bacterial, is found in the drinking water.
The conditions favorable to goitre are all found in Macabebe, but
they are also found in other parts of the islands where the disease
does not exist. There must, therefore, be some unknown factor
present (American Medicine, Nov. 18, 1905).

The Sense of Pain.— Mlle. J. Ioteyko : in one of the chapters
of her masterly report to the First Belgian Congress on Neurology
and Psychiatry, the author considers pain according to sex, age,
race, profession, pathologic conditions and in animals. By a series
of experiments the author proves what Mantegazza has said about
pain. The conditions aggravating the feeling of pain are : exqui-
site sensibility, high intelligence, superiority of race and high de-
gree of civilization, feminine sex, childhood and adolescence, a
marked degree of heat, use or abuse of coffee, and a sudden transi-
tion from pleasure to pain. There is some controversy among au-
thors as regards the meaning and degree of responsiveness to
pain by man and woman respectively. According to some au-
thors, woman is more sensitive to pain and is looked on as being
inferior to man in this respect; according to others, on the con-
trary, woman is less sensitive to pain than is man, and her sensi-
tive inferiority is pointed out against her. The unit for com-
parison is the lowest animal form that is not quite as sensitive to

THE SENSE OF PAIN. 183

pain as man is. The author demonstrates that woman resists
pain better than does man. Ottolenghi concludes from this that
she feels pain less than does man, but Mile. Ioteiko says that
woman resists pain better because she has more will power than
man has in this respect. Woman can resist the discomfort caused
by a current of 250 volts, whereas a current of 20 volts is the
medium supportable quantity. Man, however, cannot stand more
than 10 volts, no matter how much will power he invokes to help
him stand more. The superiority of woman's will power is also
indicated, according to the author, in the fact that women commit
suicide much less than do men, because women stand physical pain
more bravely than do men.

According to Richet, the sensibility to pain of idiots, imbeciles
and senile dements is stunted. According to Ley, sensibility to
pain caused by electric currents is less marked in feeble minded
than in normal children. Dolorific sensibility is also below par in
general paralytics. In normal subjects heat causes pain at a lower
temperature than in prostitutes (at 64 degrees C), criminal wo-
men (at 61 degrees C.) and especially in criminal men (at 76
degrees C). According to Nardelli there are two distinct paths
for the transmission of heat and of pain, but there are no different
nerves for this transmission. The latter author thus formulates
the conditions of sensibility to pain in various pathologic condi-
tions :

Paranoidal subjects present augmented sensibility to heat and
decreased sensibility to cold.

In melancholic women sensibility to heat is decreased (pain be-
ing perceived at 145 degrees C), while initial sensibility to cold
is markedly increased. According to the author, the thermic
hypoesthesia is due to the mental preoccupation of these patients.

Paralytic dements present similar thermic hypoesthesia, but
dolorific sensibility remains almost normal. Mile. Ioteiko con-
siders the above dissociation as an indication that there is a special
dolorific sense.

In three subjects with hemiplegia the sensation of pain and heat
was retarded on the paralyzed side, while the same test showed an
increased reaction on the healthy side.

Experiments on animals show that reaction to pain does not
depend on consciousness (a decapitated frog reacting as vigor-
ously as does a live one), as there may be reaction when conscious-
ness is abolished, the main reason of the reaction being that of
self-defense. As the function of pain is that of self-defense based
on reason and consciousness, the author concludes, pain is inti-
mately connected with the higher psychic manifestations. The

^4 CORRELATION OF BRAIN WEIGHTS.

difficulty of supporting pain makes us consider its duration ex-
tremely long as compared with that of pleasure, and the mental
impressions left by pain are, therefore, better engraved in our
minds than are those of pleasure. The role of physical pain as an
educator is self evident {Journal de Neurologie, Oct. 5-20, 1905).

Some Results o! a Study of Variation and Correlation in
Brain Weights.— Raymond Pearl: the differences between dif-
ferent races in respect to weight of brain are only in part to be
accounted for by differences in other characters of the body.
Two of the races studied (Swedish and Hessian) are sensibly
alike in mean brain weight. These are the two races out of the
four studied which on other grounds are thought to be most
closely related ethnically. Differences in mean brain weight in
different races are not to be accounted for solely by differences
in other characters. Even after Hessians, Bavarians and Bo-
hemians are put on the same basis with reference to sex, age and
stature they still exhibit considerable differences in the weight
of the brain. As a rule, the higher the mean brain weight is,
the lower the variability. All brain weight statistics agree in
showing that the brain of the male is absolutely heavier than is
that of the female. The diminution in brain weight accompany-
ing increase in age is steady and uniform throughout the adult
period of life. Beginning with about age 20 there is a steady
and uniform decline in brain weight with advancing years, up to
age 80 that was the upper limit of the period investigated. For
all practical purposes the regression may be taken to be strictly
linear. The increased line of decline of brain weight beginning
at about 50, was not found as expected. The correlation between
brain weight and age is in all series examined, except the Swed-
ish, higher for the females than for the males. This may be due
to the generally more even environmental conditions to which
women are subjected. The correlation of brain weight with body
weight is positive, and of about the same degree as the correla-
tion of the former with stature. The regression approaches some-
what more closely to strict linearity in the case of body weight
than in the case of stature. A unit change in body weight is
associated with a smaller change in brain weight than is a unit
change in stature. The correlations between brain weight and
skull length and breadth are positive and give the highest values
for the coefficients of any of those studied. For certain reasons it
seems possible that the values obtained for these correlations
from the Bohemian statistics are still" somewhat too low. The
correlation between brain weight and skull length and breadth is

A CASE OF CYSTICERCUS IN THE AQUEDUCT OF SYLVIUS. ^5

somewhat less close than is that between skull capacity and length
and breadth. The cerebral hemispheres are markedfy more vari-
able in weight than is the entire encephalon. This character is
slightly less closely correlated with stature and age than is the
weight of the entire encephalon. Regarding the mean brain
weight of different races, there are definite laws underlying vari-
ation in the weight of the brain that are not fundamentally differ-
ent from the laws of variation for the other characters of the
body. There is no evidence that intellectual ability and the
weight of the brain are in any degree correlated in normal indi-
viduals (The Journal of Comparative Neurology cmd Psychology,
Nov., 1905).

A Case of Cysticercus in the Aqueduct of Sylvius. — Dr.

Zemblinov : the case had been observed in the Saratoff City Hos-
pital. The patient was an officer of the army, 40 years of age, and
had been subject to severe headaches for four years. He had never
had any spells of loss of consciousness or of epileptiform con-
vulsions. Nor had he had any cardiac, respiratory, visual or
auditory disturbances. When admitted to the hospital, June 23,
1884, the patient was suffering from severe general headaches.
The pain in the head was constant, but somewhat less severe
for a couple of hours toward evening. There were frequent
spells of hiccoughs and at rare intervals bilious vomiting. The
motor apparatus of the eyes seemed normal on a superficial ex-
amination. The pupils were of medium size and reacted well.
The number of respirations per minute was not noted. The pa-
tient did not complain of any vertigo until about one-half hour
before death, when he complained of severe vertigo, nausea and
darkness before his eyes. He died suddenly without having had
any convulsions or other disturbances of note.

Autopsy: there was a slight scar of the liver; a cyst of the
right kidney, in its upper part, the size of a walnut, adherent to
the substance of the kidney. Findings in the brain : marked ten-
sion of the dura mater of the parietal region ; in the left posterior
parietal region the dura mater was adherent to the pia mater.
The pia mater was slightly thickened at the bases of the large fis-
sures. The convolutions were flattened. No edema. The lateral
and third ventricles were considerably distended with fluid, the
posterior horns being three times their normal size. The foramen
of Monro was considerably distended. The choroid plexus was
thickened and the pineal gland lost in its thickened folds. The
ventricular ependyma was thickened and the central ganglia flat-
tened. The choroid plexus was bluish pale, having four small

l86 CONSIDERATIONS ON THE TREATMENT OF MENTAL DISEASES.

cysts in it. On removal of the choroid plexus it was seen that
the corpora quadrigemina were flattened, the right being sepa-
rated from the left ones ; in the direction of the third ventricle,
a cyst, the size of a large pea, protruded from the aqueduct of
Sylvius. The protruding mass was part of a cysticercus with
its head, the larger part filling and distending the cavity of the
fourth ventricle. The shape of the cyst as it was found was that
of a bottle, the belly of which filled the fourth ventricle, while the
neck was inside the aqueduct of Sylvius. The diameters of the
distended fourth ventricle were : 28 mm. transversely and 35 mm.
longitudinally. When put into a dish of water, the cyst assumed
a regular shape. The walls of the aqueduct of Sylvius were thin
and the duct itself wide and short, but the lining of the fourth
ventricle seemed to be normal. The author supposes that the
scar in the liver points to an old cysticercus there, and the cyst
in the kidney are traces of undeveloped hydatid cysts. The
author calls attention to the apparent tolerance of the most vital
part of the brain, and suggests that possibly the cyst had made
its way into the cavity of the fourth ventricle just before death
took place, the head of the cyst at the same time occluding the
aqueduct of Sylvius (Mediziniskoje Obozrenie, No. 18, 1905).

5ome Considerations on the Treatment of Mental Diseases.

— Dr. J. Christian : the author disapproves of the colony treat-
ment for the chronic insane, taking the results of the treatment at
Dun-sur-Auron as proofs against the utility of the new method
of housing the insane. In the report for 1902 of that colony, it is
stated that there had been 931 patients; 2 committed suicide, 61
had escaped, 180 had changed abodes, 52 had to be returned to
asylum, 140 had to be placed in the infirmary, the total of incidents
amounting to 435, or 46 per cent. The author sees a marked
disadvantage in the lax handling of chronic insane, that neces-
sarily prevails in the colonies, the patients having free access to
drink shops all over the village. According to the author, the
farm attached to the asylum is far more advantageous than the
colony system, in which he sees nothing but an imperfect substi-
tute for a real asylum. In a spirited style, he also makes a
vigorous attack on the new modes of treating the acute insane : we
pride ourselves on having instituted non-restraint, but is it non-
restraint to keep a patient with an acute psychosis in a bath for
from six to eighteen months without interruption ? Yet this is the
treatment administered by Kraepelin to his patients at the Heidel-
berg Clinic. Attendants constantly watch the aquatic life of the
patients, using gentle suasion when the patient becomes unruly.

LOCOMOTOR ATAXIA TREATED WITH ULTRA VIOLET RAYS. 187

The author underscores the words gentle suasion, saying that the
gentleness can easily be appreciated by the black and blue marks
on the patient's arms. Besides, the patients are also subjected to
large doses of hyoscyamin. The patient's hands and feet are cov-
ered with a layer of some greasy matter to prevent maceration of
the skin, and the physician prides himself on being enabled to
keep a patient in the bath tub for as long a period of time as
18 months, without ever removing him from the tub during that
time. But, the author asks, is not such treatment restraint many
times over, and would it not be more humane to allow such pa-
tients the privilege of breathing fresh air in the court yard or in
the ward rather than the damp air of the stuffy bath room rendered
foul by the patients' excreta in the bath tubs? Some critical re-
marks are also made on bed treatment when carried to the extreme
{Annates Medico-Psychologiques, No. 3, 1905).

Locomotor Ataxia Successfully Treated with Ultra-Violet

Rays.— Dr. J. Monroe Lieberman: satisfactory results have
been obtained in 36 cases of locomotor ataxia, including 34 men
and 2 women, between the ages of from 24 to 36. Four of these
cases have been restored to good health and are now able to re-
sume their usual avocations. Twelve have been greatly benefited,
the power of coordination restored, pain abolished and the ability
to use the upper and lower limbs without any assistance estab-
lished. All are able to rise, dress and undress themselves without
any help and are sometimes able to perform such delicate opera-
tions as fixing neckties or tying their shoes in a stooping position.
In eighteen cases the disease is apparently arrested, with hope of
further improvement and final restoration of different functions.
Two died during treatment, one from lobar pneumonia, the other
of erysipelas of the head. The patients had had different forms of
treatment for years before the present treatment was instituted.
One characteristic and almost invariable effect of the treatment
with the ultra-violet rays in combination with the electric stimula-
tion of the peripheral nerves and their end-organs, is the im-
proved general nutrition of the patient. All the patients thus
treated rapidly increase in weight and improve in general health.
To facilitate these results it is all-important to maintain the nor-
mal alkalinity of the blood and secretions throughout the course
of the treatment. The items of the treatment are: 1, a warm,
half-bath at night before going to bed, with light massage; 2,
ultra-violet rays in sittings of from ten to thirty minutes, three
times a week; 3, static electricity by means of the Morton wave
current or wooden brush, daily, 15 to 25 minutes. Particular

188 VARIATION IN RELATION TO THE ORIGIN OF INSANITY.

stress is laid on the necessity of dehematization that alone permits
the penetration of the rays through the skin. The author sug-
gests the theory that the powerful stimulating effect of the ultra-
violet rays induces more activity in the natural healthy cells and
diminishes the nutrition of connective tissue, setting up a more
active local metabolism (Archives of Physiological Therapy, Oct.,

1905).

Variation in Relation to the Origin of Insanity and Allied

Neuroses.— Dr. John Macpherson: a clinical classification of
insanity, in the present state of our knowledge, is the only possible
one. General paralysis is only accidentally an insanity. As a rule,
organic diseases of the nervous system are not attended by mental
disturbances. This disease, however, is an exception in so far as it
attacks the cerebral cortex — the seat of manifestation of conscious
mind. The disease differs from ordinary forms of confusional
insanity in that its localization of attack is limited to certain parts
of the brain cortex and in the degree and severity of its virulence.
The poison causing this disease is so virulent that it affects almost
every tissue in the body. Probably some specific microorganisms
are the cause of the disease, and the syphilitic poison renders re-
sistance impossible. Confusional insanities are due to toxemia,
as shown by Dr. Bruce's researches into the numerical variation
of polymorphonuclear cells in various psychoses: there is an in-
crease of this number in some psychoses. According to Dr.
Bruce's investigations, showing a significant variation of the num-
ber of polymorphonuclear cells in the periodic groups of insanities
as well as in some forms of confusional insanities, a toxine in the
blood may be incriminated as the actual cause of the troubles. In
paranoia there is no hyperleucocytosis and no toxemia — so far as
is known. The neuropathic constitution implies three things:
structural variation from the normal type of cerebral architecture,
leading to a gross difference in the size and arrangement of the
nerve cells, or both ; 2, structural variation in the form and func-
tion of various bodily organs ; and 3, a diminished power of im-
munity on the part of the body tissues against invasion by toxines
and the products of microorganisms (The Journal of Mental
Science, April, 1905).

Contribution to the Study of the Physiology of the Thyroid
Gland i— Dr. Petrovski: ablation of the thyroid gland is fol-
lowed by lowering of the metabolic process; consequently, the
function of the thyroid gland must consist of aiding the metabolic
processes of the economy. Suspension of the thyro-metabolic

THE INSANE IN CANADA. 189

function is followed by attacks of tetany, and these attacks must
be manifestations of self-defence. That purpose is not achieved,
however : under the influence of tetanic attacks there is mostly an
increase in the nitrogeneous metabolism, while that of phosphorus
and fatty substances remains impaired. As the metabolism of the
substances entering into the structure of the nervous system is
mostly impaired by thyroidectomy, it follows that the operation
injures particularly the biochemical processes of the nervous sys-
tem. It cannot be said, however, that the function of the thyroid
body is intended to protect the metabolism of the nervous system
exclusively ; phosphorus and fatty substances also enter into the
structure of other organs. Most probably the thyroid secretions
help the process of oxidation in the tissues and promote the
process of absorption of carbonic acid gas. Andriezen holds simi-
lar views on the subject, saying that thyroidectomy should de-
crease the amount of carbonic acid gas. Albertoni and Tizzoni,
indeed, demonstrated that the amount of carbonic acid gas in the
blood is considerably decreased after thyroidectomy. The blood
of animals with ablated thyroid glands is strongly venous in nature
(Voprossi N ervno-Psychitcheskoi Medizini, April- June, 1904).

From the American Journal of Insanity, No. 1, 1905 :

1. The Insane in Canada. Presidential Address. — Dr. T. J.

W. Burgess : the history of the evolution of the Canadian Asylum
system is considered, leading up to the status of recent years. In
1901, according to the census of that year, there were in the
Dominion of Canada 16,622 insane, being a ratio of 3.125 per
thousand, or about one in every 319 of a population numbering
5,318,606 souls, exclusive of the unorganized territories. The
Provinces as regards the number of their insane stood as fol-
lows: Prince Edward Island, 361 — a proportion of 3.496 per
1,000; Ontario, 7,552, or 3.459 per 1,000; New Brunswick, 1,064,
or 3.213 per 1,000; Quebec, 5,297, or 3.212 per 1,000; Nova Sco-
tia, 1,403, or 3.052 per 1,000; Manitoba, 464, or 1.818 per 1,000;
British Columbia, 301, or 1.684 per 1,000; Northwest Territories,
180, or 1. 1 32 per 1,000. Canada shows a decided increase in the
percentage of her insane population. According to the census of
1891, there were 13,342 insane persons in a population of 4,719,-
893. In 1901, there were 16,662 in a population of 5,318,606,
being an increase, in ten years, of nearly twenty-five per cent,
of the insane, while the increase in the total population was less
than 13 per cent. Stress of life and immigration are the causes
of the increase of insanity. The author believes that insanity could
be prevented by limiting propagation among the predisposed and

I90 CYTODIAGNOSIS IN PSYCHIATRY.

degenerate. Exclusion of defective immigrants would also lessen
the increase of insanity in Canada. Canada is being made a
"dumping ground" for the degenerates of Europe. In 1901, the
population of Canada was 5,371,315, the number of foreign born
being 699,500. The total of the insane was 16,622, of which
2,878 were foreigners. This shows that there is one insane to
every 339 natives, while the proportion among the foreign element
alone is one to every 243. Speaking of the care of the insane, the
author deplores the system of appointing medical officers in the
hospitals for the insane in Canada. The "spoils doctrine," ac-
cording to which "office is a reward for political service," has done
much to keep down the progress of scientific work in the Canadian
hospitals for the insane. Merit has had little weight, especially
in Ontario, as against "political pull," the result being that almost
2/3 of the hospitals for the insane are directed by superintendents
destitute of any training prior to their appointments.

2. Cytodiagnosis in Psychiatry.— Dr. Clarence B. Farrar :
in the early stages of general paralysis cytodiagnosis is of much
value and was particularly pointed out by Professor Joffroy, in
the Journal of Mental Pathology, a. few years ago. Under normal
circumstances the liquid is crystal clear and contains no formed
elements ; at most there may be found a lymphocyte or two in one
immersion field. In paresis and in tabes dorsalis lymphocytosis is
the rule. The reaction indicates a subacute or chronic process,
just as leucocytosis or polynucleosis, as it is often called, is ah
indication of an acute process. The difference is well shown in
the various forms of meningitis. Thus, in acute meningitis poly-
nucleosis is regularly observed, while in chronic forms, such as
tubercular or luetic meningitis and meningomyelitis, lymphocy-
tosis is the rule. In a word, acute conditions are characterized by
the presence in the fluid of polynuclear leucocytes, while chronic
conditions — by the presence of lymphocytes. In paresis and tabes
lymphocytosis may be present at all stages, is particularly con-
stant during the initial period, and may be observed late in the
terminal stage. Leucocytosis may be observed mostly: in acute
congestive or inflammatory processes of the meninges, in cases of
epidemic cerebro-spinal meningitis and in those of brain abscesses.
Lymphocytosis: — in general paralysis, tabes dorsalis, cerebro-
spinal syphilis, including syphilitic meningitis, myelitis and men-
ingo-myelitis, finally, in tubercular meningitis. The conditions
furnishing negative cytological findings are : functional psychoses,
hysteriform and neurasthenic states, alcoholic insanities, involu-
tional forms, degenerative types, choreic insanity, and the manico-

EXTENSION OF TENT TREATMENT. I9I

depressive and dementia precox groups. Otherwise, practically,
every case with Argyll-Robertson pupil presents also lymphocy-
tosis. The author points out Nissl's experiments of tapping the
cerebro-spinal fluid in normal subjects, and the untoward results
that may take place even some five hours after the operation. Pa-
tients operated on should remain in the horizontal posture until
they feel completely fit to resume work.

3. Extension of Tent Treatment to Additional Classes of the
Insane.— Drs. C. F. Haviland and Ch. L. Carlisle: the tu-
bercular patients derive great benefit from tent life all the year
around. One tubercular insane doubled his weight after 14 months
of tent life, increasing from 83 pounds, on admission, to 166
pounds. Many improvements have been made in the tents, such
as inserting windows and putting the whole tent on wheels, so
that plenty of light may be obtained and sun baths had during
the day. Tent treatment has also been desirable for the filthy in-
sane and other invalids; the fresh air by day and night is bene-
ficial for such patients. In cold weather, the temperature of the
interior of the tents was maintained at from 60 to 65 degrees
F. by means of two large coal stoves in each tent. The tem-
perature could be made higher, but the above temperature has
been found most beneficial as it whips up the patient's appetite.

4. Korsakoff's Psychosis. Report of Cases — Dr. Arthur
W. Hurd : 5 cases of this psychosis are presented.

Results of the Practical Abolition of Capital Punishment in

Belgium.— Maynard Shipley: whereas the annual average of
capital condemnations during the thirty-five years 1831-65 was
9.28, the last execution occurring in 1863, the annual average of
condemnations during the thirty-five years ending with 1900, the
annual average of capital condemnations falls to 5.2, the lowest
in the history of the kingdom, while in 1900 there were but
two persons condemned for capital offences in a population of
nearly seven millions. And this despite the facts that capital
punishment is practically abolished, and that Belgium is, next to
China, the most densely populated country in the world, with a
larger consumption of alcohol per capita than that of any other
nation, with the possible exception of the Danish. The move-
ment for the abolition of capital punishment in Belgium was
started in 1827, through the publication of the monograph "De la
mission de la justice humaine et de Tin justice de la peine de
mort," by M. Ed. Ducpetiaux. Public prejudice against capital
punishment became so strong that there has been no execution

192 TOUCHES A CABLE CARRYING 22,000 VOLTS AND LIVES.

in Belgium since 1863. Since that day all the ministers of justice
have commuted every death sentence to life imprisonment with
hard labor. Pleading for the actual abolition of capital punish-
ment, the Belgian Minister of Justice, M. Le Jeune, said that it
was certain that the number of great crimes had remained station-
ary since 1830, and that the cessation of capital punishment since
1863 had in no wise determined its renewal. Notwithstanding
the prejudice against the death penalty in Belgium, all efforts
to legally abolish it have so far proven fruitless. M. Louis
Franck writes : "The restoration of the scaffold in Belgium is an
impossibility. The people no longer desire to see men die. All
they desire is to be happy in the advanced stage of their
morals" ( Quarterly Publication of the American Statistical Asso-
ciation, Sept., 1905).

Touches a Cable Carrying 22,000 Volts and Lives.— Dr.

Oldright: among other cases reported in the Dominion Medical
Monthly, Aug. 1, 1905, is that of a man who recovered after hav-
ing touched a cable carrying 22,000 volts. A burn, 4x9 inches
corresponded to the part of the wet arm that came in contact with
the live wire ; there were also deep burns on the forearm, a slight
one on the abdomen, the sole of the foot was blistered, and the
base of the great toe burned to the bone. It is found in such cases
that following the burns, the muscles frequently degenerate and
slough, even up to their insertions. The best treatment for the
burns is a dry antiseptic dressing from the beginning. A tend-
ency to hemorrhage should be expected during the separation of
the sloughs. Healing is slow owing to the depth of the burn and
the lowered vitality of the tissues. In this case the burns were
more than two months in healing, although the sloughs were re-
moved surgically and skin grafting was employed (Archives of
Physiological Therapy, Oct., 1905).

Concerning the Continuity of the Nerve Cells, and Some
Other Matters Connected Therewith. —Dr. John Turner: the
conclusions are based on personal observations with the methylene
blue and peroxide method, bringing out a pericellular beaded net-
work. According to the author, the latter is the great medium
for establishing direct connection between the different cells of
the central nervous system. A successful preparation, say from
the frontal cortex, shows myriads of delicate beaded fibrils cours-
ing in all directions, some of which can be traced for two or three
microns. These threads are as slender as neurofibrils, but usually
these latter appear of a perfectly smooth contour. The method

EPILEPSY AND DECHLORIDIZATION. 193

shows a true continuity between the different cells of the cortex ;
for not only are the intercalary cells joined together by their
processes, but also form the beaded pericellular network to which
they give rise, fibres passing directly into the axons of the pyra-
midal cells. In spite of Lugaro's protest, the continuity of the
nerve cells of invertebrates by means of neurofibrils is not a
special case, but appears to exist universally between the nerve
cells of the invertebrates so far as these have yet been studied in
this connection. There is great probability that this condition of
the nervous system occurs in all animals (The J owned of Mental
Science, April, 1905).

Epilepsy and Dechloridization.-DR. Ch. Mirallie : epileptics
habitually take a considerable amount of salt with their food. All
epileptic patients add salt to the food that is quite salt enough for
other patients. One of the author's epileptic patients is in a habit
of indulging in salt to a marked degree: whenever possible, she
takes a pinch of salt and swallows it. Dechloridization is particu-
larly effective in such cases. The author agrees with others that
a diet reduced in salt is beneficial for the epileptics because their
nervous systems are thus rendered more susceptible to the action
of bromide, much smaller doses than usual giving good results.
There is a marked decrease of the number of fits during the period
of dechloridization; the number of attacks increases when the
usual diet is resumed, but the number does not quite reach the
original number of attacks. In some cases, on the contrary, the
special diet with reduced salt causes a marked increase in the
number of attacks. This the author explains thus : while the ner-
vous cells become more responsive to the action of bromide, they
also become more susceptible to other excitant agents, such as
wine and alcohol. The group of patients who suffered an increase
in the number of fits were employed in the wards of the hospital
as houseworkers, and daily rewarded by some wine and alcohol,
the harmful effect of which were rapidly shown by the increased
number of fits. A milk diet greatly helps reduce the number of
fits (Gazette Medicate de Nantes, Oct. 14, 1905).

Tabes Dorsalis In Children.-DR. M. S. Margules: up to the
present date there have been only 23 cases published, the author
adding one, which makes in all 24 cases. Of that number, 14 were
girls and 10 boys. The author's case is that of a girl, 8 years of
age, whose father is a moderate alcoholist and both father and
mother are subject to latent syphilis. Atrophy of the optic nerve
occurs in 12 per cent, of the cases in general, but in many more

194

INEBRIETY AND THE SO-CALLED CURES.

cases in children. Fourteen of the 24 cases described presented
marked atrophy of the optic nerve, 4 of the cases showed various
stages of that atrophy, while in 6 of the cases there were no alter-
ations of the optic nerve. The course of the cases with this
atrophy is particularly chronic, the preataxic period being con-
siderably prolonged. In the author's case, the sclerotic process
along the blood vessels was marked. Examination of the eye
ground is of the utmost importance for diagnostic purposes. The
number of cases of tabes dorsalis among children is small because
of the great mortality from syphilis among young children. Ac-
cording to Engel-Reimers, 63.5 per cent, of the children born of
syphilitic mothers died under one year of age, 75 per cent, of that
number showing distinct signs of syphilis. Not all syphilitics are
prospective candidates for tabes dorsalis; possibly severe infec-
tions only cause the disease (Mediziniskoe Obozrenie, No. 17,
1905).

Inebriety and the So-Called Cures. — Dr. James Stewart : in-
ebriety and drunkenness should not be confounded, inebriety being
a disease, while drunkenness is a vice. Inebriety is accompanied
by changes of the nervous system, especially injuring the centres
of memory and will power. Considering the physical damage
caused by alcohol, it should not be expected that a "gold cure,"
hypnotism or injections of apomorphine will cure the patient at
short notice — as many chalatans claim to be able to accomplish
cures for inebriety. Forty-one per cent, of the cases of both sexes
treated at the Dunmurry Home during the last ten years had pre-
viously been under the care of "Dr. Topsy" or some other light-
ning curer of inebriety. In every one of these cases the patient
said the benefit was only temporary, the duration of the immunity
depending on the occupation or surroundings of the patient after
the so-called "cure" had been affected and the condition of the
general health. All looked on the expenditure of the "cure" as
waste of both time and money. According to the author, the in-
ebriate must for at least twelve months be placed in such sur-
roundings as experience shows are favorable for the carrying out
of the work of restoration of the injured brain cells — a work that
should not be interrupted, and that cannot go on if alcohol in any
quantity, even the smallest, be taken by the patient. The pro-
tection of the patient can only be secured in a properly organized
"home" {Bristol Medico-Chirurgical Journal, June, 1905).

Psychologic and Clinical Study of Echopraxia. — Dr. Dro-
mard: echopraxia is an impulsive or automatic imitation of ges-

EPILEPTOID FOOT TREPIDATION AND SURGICAL ANESTHESIA. 195

tures, the imitation being immediate and characterized by abrupt-
ness and promptitude of a reflex nature. Reason or volition do-
not intervene, as the subject afflicted with echopraxia promptly
imitates any act he sees performed, laughing when he sees some-
body laugh, crying when he sees somebody cry, throwing himself
from any height at which he happens to be when seeing anybody
fall from a height, etc. According to Hammond, the disease is
known in Yakutsk under the term miryachit, in Germany, a similar
affection is described under the name of S chaff trunkenheit, a spe-
cial inhibitory enfeeblement favoring all these varieties of echo-
kinesia. The psychology of the disturbance is similar to that
causing the manifestation of tics. Extreme susceptibility of the
subjects plays an important part in the disturbance. This sus-
ceptibility to suggestion is marked in the dement in general and in
dementia precox in particular. In the latter dementia the imi-
tative propensity is well known to clinicians. In all these cases
there is incontinence of the lower centres while the higher ones
fail to act for various reasons, according to the case {Journal de
Psychologie Normale et Pathologique, No. 5, 1905).

Epileptoid Foot Trepidation and Surgical Anesthesia. — Dr.

Lannois: the various sensibilities, including cutaneous reflex, dis-
appear during the course of anesthesia, but the foot clonus makes
an exception to this rule. This clonus appears as soon as the
corneal reflex disappears, and the deeper the anesthetic sleep, the
more marked is the foot clonus. This clonus is found in 2/3 of
anesthetized subjects well under control of the anesthetic, but in
some cases the reaction cannot be obtained even when there is
profound anesthetic sleep. The clonus may also appear on one
side only. In two cases with cortical lesions the trepidation ap-
peared on the side opposite to that on which the lesion was, but
not on the same side. The epileptoid trepidation appears after
the onset of complete muscular resolution ; hence, there is no cor-
relation between muscular tonicity and foot clonus. It has been
suggested that probably there is an intermediary centre between
that of the knee reflex and the higher reflexes producing the
foot clonus. The author observed as a constant occurrence ces-
sation of the foot clonus in cases where respiration was sus-
pended by some accident. According to the author, the centre
of the foot clonus is probably somewhere in the lumbar enlarge-
ment of the spinal cord; the reflex is probably produced by ex-
citation of the lumbar cells by the chloroform or ether. Re-
marking on this reflex, Dr. Croeq said that the phenomenon was
of importance and would tend to show that it has been errone-

196

THE RELATIVE NUMBER OF MEN AND WOMEN.

ously supposed up to the present that exaggeration of the knee
reflex coincided with the foot clonus, and that the clonus should
not be considered as a necessary accompaniment of exaggerated
reflexes. Dr. Lannois claims also to have seen the foot clonus in
a case of section of the spinal cord; in a case of Pott's disease
he found abolition of the knee reflexes with epileptoid trepidation
of the feet. In exophthalmic goitre, typhoid fever and some other
affections these conditions are common (Journal de Neurologie,
Nov. 5, 1905).

The Relative Number of Jlen and Women. — According to
Frau Gnauck-Kuehne, the superfluity of women in so many Euro-
pean countries is rapidly disappearing, and in another twenty years
there will be a superfluity of men even in such countries as Ger-
many and England, where at the present time women pre-
ponderate. In Luxembourg, in 1890, there were 1,002 women for
every 1,000 men, while there are now only 999 women for every
1,000 men. In Austria the proportion has been reduced in the
same time from 1,044 to I?°35J *n Hungary, from 1,015 to 1,009;
in Switzerland, from 1,057 t0 I>°35J m Sweden, from 1,065 to
1,049; m Germany, from 1,040 to 1,032; in England, from 1,055
to 1,047. She does not believe that any European nation except
Russia will long continue to increase rapidly in proportion. Eng-
land has begun to follow the example of France in the matter of
decreased birth rate, and Germany is considered as having begun
the downward path of birth rate. In all advanced European coun-
tries the birth rate is either becoming stationary or shows a tend-
ency to regression.

Contribution to the Study and Interpretation of Vibro-
sensibility. — Drs. V. Forli and B. Barrovecchio : the results
obtained by the authors are similar to those obtained by other in-
vestigators, differing from them in some particulars. In the aged,
the perception of the vibrations of the tuning fork is impaired.
The perception is equally marked in men and in women respect-
ively. In one case of sclerose en plaques, the vibrosensibility was
normal. Rydel and Seiffer obtained opposite results in three
such cases. In patients subjected to spinal cocainization there is
distinct dissociation between thermo-dolorific anesthesia on the
one hand, and conservation of tactile and vibrosensibility, on the
other. It may be supposed that the latter two sensibilities are ex-
pressions of similar sensory qualities. The deep tissues only per-
ceive the vibrations of the tuning fork (aponeuroses, muscles,
bones, peritoneum, omentum). The subjects on whom the ex-

HALLUCINATIONS AND HALLUCINATORY PSYCHOSES. 197

periments were performed were cocainized prior to the application
of the tests. It should be possible to learn whether there are dis-
turbances of the deep sensibilities, as explained, while the cutan-
eous sensibility remains intact (Annali dell'Istituto Psichiatrico,
Vol. III., No. 2, 1904).

On Hallucinations and Hallucinatory Psychoses — Prof.
G. Angiolella: the sensorial and sensori-perceptive process
represents and constitutes the essential and fundamental basis
of all psychic life. Psychic disturbance is therefore due to some
pathogenic lesions of the sensorial and sensori-perceptive centres.
As alcohol localizes its hallucinatory action in certain centres, so
other poisons, the nature of which is not known to us, probably
localize their action in given centres and imprint given character-
istics to the morbid manifestations accompanied by hallucinations.
It is known, for instance, that epilepsy may be substituted by a
spell of "psychic epilepsy," showing that a given pathogenic
agent may act either on the psycho-motor or on the sensori-per-
ceptive sphere. Emotion may act as a pathogenic agent by caus-
ing chemico-molecular changes and consequent production of
pathogenic agents in the organism — particularly in the nervous
system. A case of hallucinations, delusions of persecution and
attempted suicide is cited and the findings at the autopsy are
given. The brain presented marked lesions of the gray and white
substances of the right lower parietal convolution — correspond-
ing to the site of a trauma received during childhood (II Mcmi-
comio, No. 1, 1905).

Objective Signs of Hallucinations. — Dr. Zaregradski:
The study is limited particularly to hallucinations of hearing. It
is claimed by some that under those conditions the external part
of the ear, and more particularly the tegument near the tragus
becomes furrowed. Of 55 cases of auditory hallucinations, 14
did not present that sign, while 41 of the cases presented the
peculiarity with different variations. In one case of unilateral
hallucinations it was found that the furrows existed on the affected
side while they were absent on the healthy side. In one case the
furrows corresponded to animated mimic expressions of the face.
Laughing or crying was accompanied by marked contractions of
those furrows. The latter were particularly marked in cases
in which hallucinations had been of some three years' duration
and more. The subjects examined were between the ages of from
2 5 to 50 years. The furrows were particularly marked in subjects
above 38 years of age. In some cases the furrows were more

198 sexual continence.

marked on one side or absent on both sides. The presence of
the furrows during the course of auditory hallucinations cannot
be said to be without any significance (Vestnik Doushevnich
Boleznei, No. I, 1905).

Sexual Continence.. — Can sexual continence be a cause of
neuroses and psychoses? The personal qualities of the subject
play an important part in this matter. Subjects in good physical
and mental condition do not suffer any untoward symptoms from
the practice of continence. Albrech von Heller tested on him-
self the effect of continence. At first he suffered from headaches
and general malaise, but this was soon replaced by a condition
of mental alertness and vigor. The author states that continence
may be absolutely harmless when practiced by men of serious
minds and wholesome mental occupations, leading regular lives
and living on simple but good food. For women it is much
easier to practice continence, but they should have some whole-
some mental work to keep their minds busy. The degenerate
and neurasthenic may find it harmful to practice continence, but
sometimes they are also considerably harmed by marriage — that
sometimes serves as an exciting cause of psychoses or neuroses
{Mental Diseases, Prof. Kovalevski, pp. 232, 233, 1905).

Histo-Pathologic Researches Into Paramyoclonus Multi-
plex.— Dr. E- Poggio: cerebrum: slight atrophic alterations with
moderate lipochromatosis in a discrete number of cells and uni-
formly distributed in the convolutions. Spinal cord: lipochromes
in the majority of the radicular cells and in those of Clarke's col-
umn. The radicular columns presented, besides the lipochromes,
marked lesions in their entire height, especially in the lumbar
region. The lesions were of longer standing in these columns
than in Clarke's column. The other spinal cells presented lesions
similar to those described in the brain. There was no neuroglia
proliferation in the entire cerebro-spinal axis. There were slight
vascular alterations, but neither perivascular nor pericellular in-
filtration. The author does not present these as typical lesions
of paramyoclonus multiplex, but simply states that such was the
condition in his case (Rivista \di patologia nervosa e mentale,
April, 1905).

A Case of Traumatic General Paralysis.— Dr. Wahl
has had occasion to observe a case of general paralysis that was
due to a traumatism received in the left parietal region of the
head. The subject's history was negative, and, so far as was
known, he had never had syphilis.

CLINICAL SIGNIFICANCE OF DEMENTIA PRECOX. jgg

Discussing the case, Prof. Joffroy remarked that too much im-
portance was ascribed to syphilis as a cause of general paralysis.
The incrimination of syphilis as above was due to an erroneous
scientific reasoning. An etiological connecting link is always
necessary between syphilis and general paralysis. In Dr. Wahl's
case the connecting link was the traumatism, without which
general paralysis would not have manifested itself. From a
medico-legal point of view, it is right to allow a pension to sol-
diers under circumstances described above. The patient de-
scribed above was a soldier (Annates Medico-Psychologiques,
No. 2, 1904).

General Considerations ol the Clinical Significance of
Dementia Precox. — Dr. Meeus: The hebephreniac and cata-
tonic form of Kraepelin represent, — one a slight, and the other a
graver form of the same disease. The author suggests that more
definite terminology be used in regard to the forms of the dis-
ease in question. Thus, hebephreno-catatonic dementia unites
in one title both the notion of the historic evolution of the dis-
ease, its special features and age of onset. Many other impor-
tant considerations of the question are presented (Annates
Medico-Psychologiques, No. 2, 1904).

The Element of Truth in Mental Mealing. — Dr. Lucy Waite :
there are many cases of what the author calls mental indigestion.
Such patients are generally preoccupied with some thought or
other that makes them feel unhappy, causing insomnia, headaches
and dyspepsia, and even driving them insane — for want of proper
treatment: the specialist does not see in them classic types of
insane, while the general practitioner is at a loss to understand the
true nature of the trouble. In a large number of such cases want
of proper mental employment is the cause of the disturbance.
Rest has been known to us as a therapeutic agent for many years,
but work- — as a therapeutic agent — has not been thought of, ac-
cording to the author. Cases are cited in which work relieved
mental suffering and consequent insomnia, indigestion and head-
aches (New York Medical Journal, August 19, 1905.)

Race Suicide in France. — According to M.Bertillon, the num-
ber of children born in France last year was only 818,229; this is
the smallest number registered of late years. The number of
children born this year is said to be 150,000 less than in 1871.
During the last year the population of France was increased by
only 57,000, while that of the United Kingdom had an increase
of half a million, and Germany, 812,000. The population is rated

200 SIXTH INTERNATIONAL CONGRESS OF CRIMINAL ANTHROPOLOGY.

at 39,000,000 inhabitants. The quinquennial census of the Ger-
man Empire, taken December 2, exceeds 61,000,000, against 56,-
345,000 in 1900. The birth rate in Germany is slowly receding,
however. According to Dr. Ebers, it is not probable that the
population will ever reach the mark of 70,000,000.

Sixth International Congress of Criminal Anthropology.—

The Vlth International Congress of Criminal Anthropology will
take place in Turin, Italy, April 28, 1906. The local committee
consists of a number of distinguished men, headed by Professor
C. Lombroso as President. Among the subjects to be treated are
announced :

Treatment of young criminals according to the principles of
criminal anthropology, by Prof. Van Hamel, Holland. Treat-
ment of criminal women, by Dr. Pauline Tarnovskaja, St. Peters-
burgh. Relation between economic conditions and criminality,
by Dr. Kurella. Equavalence of different forms of sexual psycho-
pathias and criminality, by C. Lombroso. Criminal anthropology
in its relation to scientific police organization, by Ottolenghi.
Psychologic value of testimony, by Brusa. Prophylaxis and thera-
peutics against crime, by Enrico Ferri. Institutions for per-
petual detention of criminals declared mentally irresponsible, by
Garofalo.

Subscription for membership is twenty lire. All communica-
tions and subscriptions should be addressed to the General Sec-
retary, Prof. Mario Carrara, Institute of Legal Medicine, 26, Via
Michelangelo, Turin, Italy.

Fifteenth International Congress of riediclne w;ill be held
in Lisbon, Portugal, April 19-26, 1906. All communications
should be addressed to the Secretary, Hopital de Rilhafolles, Lis-
bon.

A Veritable Social Peril, Voluntary Depopulation. — Prof.
G. Eustache: in 1850, the population in Germany and France,
respectively was about the same — 35,000,000. To-day, Germany
has over 61,000,000, whereas France's population is only 39,000,-
000. The author claims that the reason of this rapid decrease
in population in France is due to the large number of divorces, in-
creasing in greater proportion than does that of marriages ; exces-
sive death rate among children, and voluntary decrease in popula-
tion through prevented conceptions and criminal abortions. In
1904, the population for France was the lowest recorded in the
XlXth century. The number of births in 1903 was 826,712,

EARLY TREATMENT OF MENTAL AND NERVOUS CASES. 20I

whereas in 1904, the number was only 818,229. Statistics from
one hospital in Paris, Boucicaut, taken at random, show that there
is an alarming number of abortions in that city: thus, in 1898
there were 45 confinements before term as against 102 similar
confinements in 1904. There were also 43 abortions recorded in
that hospital in 1898, as against 130 abortions in 1904. According
to the author, more energetic teaching of morality in the primary
schools would remedy the evil {Journal des Sc. Medicates de Lille,
Nov. 25, 1905).

Some Points in the Early Treatment of Mental and Ner-
vous Cases (With Special Reference to the Poor). — Dr. A.

Helen Boyle: this year, the Council of the Lewes Road Dis-
pensary for Women and Children in Brighton has opened a small
hospital, one of its principal features being that all nervous cases
are eligible for admission except those requiring restraint and
suitable for asylums. The author claims that more such hospitals
are needed, as there are many patients who would escape becom-
ing insane if they were properly treated before they break down
so that they are technically insane. In other words, she says,
insanity begins before a person is insane, and it is then that recog-
nition and skilled treatment are most valuable. Clinics for such
cases are in operation in Germany, — in Berlin, Munich and in
many provincial places. In institutions for such cases there should
be an entire absence of red tape, and the type of building that
would probably suit best would be cottages. The cost should
work out somewhere between that of asylums and general hos-
pitals in England. At the Brighton Hospital, with twelve beds
only, the cost will probably be about 15 shillings a week per capita
— possibly less (The Journal of Mental Science, Oct., 1905).

Peculiarities of Memory in Progressive General Paralysis. —

Dr. Zacharchenko : the most striking impairment of memory is
in the sphere of mechanical memory, such as memorizing sense-
less words or sentences. Memory based on association of ideas
and active attention is much less impaired. From the standpoint
of the component parts of memory these facts are of interest.
In cases of Korsakoff's disease, the impairment of mechanical
memory is far less marked than in general paralysis, whereas
memory requiring association of ideas and attention is far more
marked in Korsakoff's disease (Voprossi Nervno-Psychitcheskoi
Medizini, Vol. IX, 1904).

202 MOTHER KILLS HER SEVEN CHILDREN AND SELF.

Mother Kills Her Seven Children and Mortally Wounds
Herself. — According to the New York World, Oct. i, 1905, Mrs.
Lydia Markum, of Cambridge, 111., killed her seven children, rang-
ing from twelve years to an infant in arms, piled up their bodies
on the floor, covered them with bedclothing saturated with oil,
set fire to the house and mortally wounded herself. In a rural mail
box a letter was found from Mrs. Markum to her husband, in
which she wrote that she was going to kill the children and her-
self, saying : "I love you and the children, but there is no happiness
on this earth, and they will be happier and safer in the arms of the
Lord."

The family was poor, and the woman's struggle to rear her chil-
dren, combined with loneliness and lack of recreation is supposed
to have unbalanced her mind

Stereotyped Dreams. — Dr. Meunier: in normal subjects
dreams vary with the cenesthesia of the subject, whereas in some
pathologic conditions dreams are stereotyped. This condition of
stereotypia in dreams is particularly characteristic of epilepsy and
hysteria and of some psychoses with fixed ideas of old standing.
There are some cases, however, in which stereotypia in dreams
is due to impressions of childhood days {Journal de Psychologie
Normale et Pathologique, No. 5, 1905).

A Detail in the Russian Revolution. — In a small village on
the Baltic Sea a manifesto was issued, the first week in December,
abolishing the rule not only of the Emperor, but also of the
Deity. It is reported that the manifesto has been read in the
churches and the popular assembly halls.

Chinese Sympathy for the Jews.— December 3, a company of
some forty Chinese, under the auspices of the Chinese Empire
Reform Association, presented "King David" at Miner's Bowery
Theatre for the benefit of the suffering Jews in Russia. Nearly
$1,000 was realized.

Dechloridization, Bromism and Status Epilepticus. — Drs.

Voisin and Rendu : this method was used in the treatment of 15
epileptics, potassium bromide being given in doses of 4 grams.
The number of attacks and vertigo was decreased (11 attacks
against 272, and 12 spells of vertigo against 198), but there were
signs of bromide poisoning (acne, titubation, somnolence) and
mental disturbances (melancholic depression and hallucinations).
In five cases there was status epilepticus and one patient died
(Progres Medical, Nov. 25, 1905).

A HOSPITAL FOR INEBRIATES IN NEW YORK. 203

A Hospital for Inebriates in New York will be organized
in New York City this coming summer. According to the Quar-
terly Journal of Inebriety, No. 3, 1905, Legislature has passed
a bill to provide for the establishment in this city of a hospital
for confirmed drunkards and habitues who may be committed
from the police courts and other courts of the city and State.
The building and site will cost over $300,000, and be paid out of
the excise money. There are about 30,000 persons arrested for in-
toxication in New York during the year.

Antitoxin for Mushroom Poisoning : Dr. W. W. Ford, of
Johns Hopkins University, has obtained the toxin by boiling and
filtering the poisonous species of mushrooms, and with this he
immunized small animals, according to the method used in obtain-
ing the diphtheria antitoxin, thus securing a protective serum. As
yet the substance has not been tested on a human being {American
Medicine, Dec. 9, 1905).

Absence of Glucose in the Cerebrospinal Fluid. — Dr. Du-

bos : the substances in the cerebro-spinal fluid that reduce Fail-
ing's solution are not glucose. Reactions to demonstrate this are
indicated in detail. The reducing substances are creatin, creatinin,
xanthin and hypothantin — results of metabolic changes (Annales
Medico-Psychologiques, No. 3, 1905).

Clinical Contribution to the Study of Ocular Paralyses.

— Dr. Giovanni Fabrizi presents a valuable clinical study
of ocular paralyses. Among other interesting facts, he reports
two cases of congenital blepharoptosis and one of congenital
bilateral paralysis of the external oculo-motor muscles (Annali
delVIstituto psichiatrico di Roma, Vol. Ill, fasc. 1, 1904).

Laminectomy of the Third and Fourth Lumbar Verte-
brae for a Lesion of the Cauda Equina. — Prof. Roberto Ales-
sandri: the wound was healed within seven days from the day
of the operation, and satisfactory results were obtained (Rivista
di Patologia nervosa e mentale, February, 1905.)

Warning to Physicians of Colorado, — In Colorado it is for-
bidden by the law to give a prescription for alcohol to anybody
without making an examination of and without a fee from the
patient. Violation of this law renders the physician liable to a
fine of from $100 to $300 (American Medicine, Nov. 18, 1905).

204

BOOK REVIEWS.

Syndrome of Brown-Sequard. Wound of the Spinal Cord.

— Dr. Couteaud: the patient sustained a more or less complete
section, of the right half of the spinal cord, in the region corre-
sponding to the dorsal side of the brachial segment. The syn-
drome was fully manifested only after five days following the in-
fliction of the wound {Gazette des Hopitaux, Nov. 21, 1905).

Multiple Births and Heredity — Mrs. W. W. Wilson, of Los
Angeles, gave birth to triplets for the second time, Nov., 1905.
She is herself a twin and has two aunts who also have borne trip-
lets.

BOOK REVIEWS.

Studi 5ulla Pazzia Nella Proviacia tii Roma. Confront!
Internazionali. Dr. Augusto Giannelli, Senior Physician of
the S. Maria delta Pieta Hospital for the Insane, Rome, Privat-
Docent of Psychiatry and the Psychiatric Clinic, Rome. Ludo-
vico Cecchini, Rome, Publishers, 1905. The study embodied in
this work is statistical and clinical, comprising 18,338 admissions,
during a period of 74 years, in the XlXth century (1811-
12 and 1 829- 1 900) ; the data for the missing years of that century
are either wanting or incomplete. Historic chapters precede the
study properly speaking, presenting valuable information of social
and historic significance on the founding and growth of the Hos-
pital for the Insane at Rome, Italy. The Hospital was founded in
1548. Want of space prevents a detailed analysis of this work,
and a simple enumeration of the headings of chapters with an
analysis of some of the chapters will be presented here. Some of
the headings are :

Historic considerations. The population of the hospital during
the twenty years 1881-1900, with especial reference to some psy-
choses since 1870. Insanity in its relation to sex, age, civil state
and education. Insanity among Jews. Insanity according to
profession, month and season of the year. Mortality according
to age. Insanity in relation to altitude. Distribution of insanity
in the Province of Rome, with particular reference to general
paralysis of the insane, alcoholic and pellagrous psychoses. In-
sanity in the Province of Rome in the XlXth century as compared
with insanity in other provinces and in foreign countries.

During the twenty years 1 881 -1900, the largest number of ad-
missions were those of general paralysis (1,368), alcoholic in-

BOOK REVIEWS. 205

sanity (1,337), maniacal psychoses (1171) and epileptic psychoses
(1,033) ; tnen f°ll°w the melancholic forms (886) and the
neurasthenic varieties (633). The author considers that there is
a direct relation between syphilis and general paralysis of the
insane, stating that deaths from syphilis and general paralysis
respectively are of importance in the Province of Rome : half of its
population is in the capital, in the hospitals and asylum of which
the majority of the cases of syphilis and general paralysis re-
spectively end in death.

Alcoholic insanity has decreased in Rome during the last ten
years, and the continuous decrease of this form of insanity among
women since the ten years 1871-1880, is quite the opposite of that
seen in other capitals. In Paris the increase of alcoholic insanity
is enormous, women furnishing almost as large a proportionate
increase as men do. Alcoholism is the most common cause of
epilepsy and idiocy.

During the twenty years 188 1- 1900, ten patients committed
suicide : 5 men — 0.08 per cent, of the 6,298 men admitted ; and 5
women — 0.13 per cent, of the 3,859 women admitted. These data
are lower than those obtained for the period 1874- 1880. During
1881-1900 there were three patients killed by homicidal patients.
The total number of admissions during the same period was
10,361. Of this number 204 were discharged as not insane. The
mean population during the same period was 1,045,481.

There has been a gradual and marked increase in the number
of women general paralytics: in 1871-1880 the proportion of
women to men general paralytics was 1 16.5 ; in 1881-1890 the
proportion was 1 -.3.34 and in 1 891-1900 it increased to 1 12.34.
In other words, the number of men general paralytics has almost
tripled, while that of women is seven times more marked than
it was in the first indicated period.

The figures relating to sex and insanity should be read, other-
wise the correct idea of this relation is apt to suffer when ex-
pressed in bare figures.

Subjects born outside of wedlock furnish a larger proportion
of insane than does the general public. Besides, epilepsy and the
senile psychoses are in larger proportion among these subjects,
while there is no difference in the respective proportion of general
paralysis.

Public instruction is not a cause of increase of insanity.

There is no special racial psycho-pathology, but certain political
conditions, oppressing given races, have lead to an increased pre-
disposition to insanity in given cases. Other causes, such as lack
of racial mixture, go hand in hand with the former cause. The

2o6 BOOK REVIEWS.

Jews are especially predisposed to hysterical disturbances and
neurasthenia, while epilepsy is rare among them. There are also
given psychoses that are more frequent among them. Moral
depravity is rare, while periodic insanity is of frequent occurrence.
Few of Jewish children are idiots, but a large number of them are
neurasthenic since early childhood. During the period of 1881-
1900, there were, in the Province of Rome, 5.26 insane per 10,000
Jews against 3.72 per 10,000 Roman Catholic inhabitants
in the same Province. Among the Jews there are also a larger
number of men insane as compared with that of their wo-
men than there are among the Catholics. In the Province
of Rome, the number of admissions of Jewish epileptics and alco-
holists is smaller than that among the Catholics. Among the Jews
the percentages are more marked in the same Province for the
following psychoses: maniacal conditions, hysteria and general
paralysis. Nations of the blond and light complexions are more
predisposed to melancholia than are those of dark complexion.

In the Province of Rome the maximum admissions take place
in March-June; there is a decrease, beginning with July, that
reaches a minimum in September — when it is still quite warm in
Rome. This minimum is smaller than that reached in January.
September gives the absolute minimum of admissions. The
paroxysm of insanity is precipitated in the Spring. The largest
number of insanity is controlled by actinometric rather than by
thermic maxima.

Extreme altitudes and flatlands are also important factors in
relation to the condition of the human mind. The water supply,
geologic and climatic conditions, however, have much to do with
the above altitudes in their relation to the progress of mentality.

An analysis by counties (communes) in the Province of Rome
shows that some did not furnish any insane, while others fur-
nished insane of one sex only. The author did not find any direct
relation between alcoholism and general paralysis.

The change from the papal to the temporal government did not
cause any increase in insanity : public instruction helped the people
to understand that insanity should be treated, and a larger number
of admissions resulted. Great political upheavals do not cause
any increase in insanity. The admissions during the revolution-
ary periods in France and in Italy respectively do not show any
increase during those troublous times. To-day, the increase of
insanity in Italy is due to the extreme stress of life.

The analysis of the asylum population during the second half of
the XlXth century shows that the increased number of admis-
sions is due to a better understanding by the people of the mean-

BOOK REVIEWS.

207

ing of insanity as well as to the better treatment accorded to the
insane. There is a slight increase of insanity in the suburbs of
Rome. This is due to extreme economic misery and emigration.
In Rome properly speaking there is rather a slight decrease of
insanity than an increase. Civilization is not a cause of insanity.
The vast material collected in this large volume of 497 pages,
illustrated with 23 tables and charts, is handled not in the simple
manner of simple representation: the author, who is well known
to the psychiatric world for his accomplishments in neurology and
psychiatry, has proven himself in this work to be an able
correlator of facts as well. By his power of correlation he has
succeeded in presenting to the world a scientific history, pointing
out the particular social, political, religious and ethnographic
significance of facts that have hitherto conveyed little, if any,
meaning to the reader. The volume is a valuable reference book
on the subject of statistical data about the insane from the stand-
point of applied knowledge.

Le Syndrome de la Nevrose Ascendante (Nevrite Ascen.
dante Regionale). Clinique et Experimentation. — Dr. J. A.

Sicard. Francis Simon, Rennes, 1905. Clinical conclusions : the
term ascending neuritis should be applied to a regional syndrome
following a local toxi-infection, the syndrome being slow, pro-
gressive and ascending from the periphery to the central nervous
system, with a possibility, however, of regression and cure. In
the affected region the pain is acute and of paroxysmal nature.
The etiology is always a severe or slight localized toxi-infection,
most commonly of traumatic nature; the microbe is generally a
common one.

The pains are ascending and irradiating, the nervous trunks
hypertrophied, easily felt by palpation. Radiographic study
shows rarification of the bone in the region corresponding to the
affected area. This rarification is one of the earliest and most
important signs in the affected area. Among the later and secon-
dary signs are: objective disturbances of sensibility peripherally,
disturbances of motility, reflexes, trophism and electric reaction.

Anatomically : interstitial reaction of the nervous branches and
trunks, with augmentation of volume and secondary degeneration
of the axis cylinder and myelin. This neuritis is, therefore,
primarily interstitial and secondarily degenerative.

Topographically, there is a disto-central ascending neuritis, as
in the case of wounds of the fingers, etc., and proximo-central, as
in the case of infection of the trigeminus from a dental abscess.

According to anatomical research, ascending neuritis never

208 BOOK REVIEWS.

reaches the central nervous system by direct continuity. It is
possible, nevertheless, to obtain central reaction through irritation
a distance.

Experimental conclusions: the clinical facts related above are
confirmed experimentally. Microbe infection may cause exten-
sion of the ascending neuritis to the central nervous system, but
the infection in such a case is no longer confined to the nerve
alone, but is generalized and rapidly causes death. In all the ex-
periments in which septic poison had been carefully injected into
the nerve properly speaking, the neuritis that followed was simple
regional, without ever reaching the spinal parenchyma — not even
in the experiments covering a period of from six to seven months.
These facts show that the role of the nerves in regard to microbes
is that of preventing microbic propagation in the direction of the
central nervous system.

Contribute Alio Studio Clinico Dell' Emicranla (Semplice e
Accompagnata). With a Preface by Professor Q. Mingaz-
zini. By Dr. Mario Augusto Bioglio. Tip. Operaia Romana
Cooperativa, Rome, 1905. This monograph of 206 pages is di-
vided into two parts, one treating of hemicrania from a clinical
point of view, and the other being taken up with clinical histories
of sixteen cases. The first few chapters are devoted to the con-
sideration of the definition, etiology, pathogenesis and anatomical
pathology, differential diagnosis, prognosis and treatment of hemi-
crania. The remainder of the first part of the work is taken up
with the consideration of the relation of hemicrania to epilepsy
and hysteria. These affections are considered in relation to one
another from the neurologic, psychiatric, oniric and anthropologic
points of view. There is also a study of the pulse and tempera-
ture during the course of the different neuroses mentioned. In
the concluding remarks the author devotes about three and one-
half pages for the enumeration of the conditions of dissimilarity
between epileptic and hemicranic subjects respectively. The dis-
similarity is considered from the following points of view : anthro-
pologic, neurologic, clinical, hereditary and psychic. It is finally
concluded that not all persons subject to hemicrania are either
epileptic or hysterical, but the three neuroses belong under one
heading of degeneracies. Prof. Mingazzini's classification of
hemicranias is accepted by the author. A tabulated biblio-
graphical index of ten pages in small type is appended to this
monograph.

The Journal of Mental Pathology

Vol. VII. 1906. No. 5.

A CRETIN DOG AND ITS THYROID
APPARATUS.

(From the anaiomo-patholo gic laboratory of the Psychiatric
Clinic, Royal University, Prof. Tamburini s Service,

Rome, Italy.)

By Drs. Ugo Cerletti and Gaetano Perusini.

The ancients were familiar with the fact that the mammalia
were subject to goitre in a manner similar to that observed in
man. Aristoteles, Columella, Plinius, Gallius and Aetius speak
of enlargement of the "glands" of the neck in animals. On close
examination their remarks seem to refer to the thyroid gland.
Goitre was observed by the ancients in various species of mam-
malia in endemic regions. Among those mentioned are cats, dogs,
oxen, horses, camels, mules, goats, antelopes (Amour, Siberia),
etc.

In our first paper on endemic cretinism (5) we particularly
pointed out the important role played by hypothyroid heredity
especially on the mother's side ; we considered endemic cretinism
as a heightened morbid heredity characterized by hypothyroidism.
We presented this notion provisionally — pending the discovery
of the exact pathogenic agent of goitre in its various forms.
While making our researches into endemic goitre in man it oc-
curred to us that it would be of interest to consider the same dis-
ease in animals living in endemic regions, particularly so because
it is known that animals living in such regions are not all free
from the affection.

Several observers have treated of endemic goitre in animals,
t>ut the handling of the subject is incomplete. Raynard (27), for
instance, touching on the question of goitre in dogs, speaks of
animals with "large heads, short necks, underdeveloped bodies
and limbs, comparatively stupid from various points of view,
idiots, and born with this disease." Billiet and Morel (3) speak
of dogs "characterized by voluminous heads and necks, crooked
limbs, slow movements and lack of precision. They are not at-

2I0 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

tached to their masters and their animal function alone seems to be
in order. They are a kind of idiots, sheer cretins that are de-
stroyed on account of their homeliness and uselessness." St.
Lager (29) also observed that the "fur of animals subject to goitre
was coarse and stiff, their voices hoarse and their hearing im-
paired. Such animals were indolent and some of them fell into
a condition of torpor that one could not help comparing to that
characterizing cretinism." Finally, Moussu (26) gives a descrip-
tion of cretin chickens that presented "trophic disturbances char-
acterized by overgrowth of plumage" similar to the overgrowth
of bristle in thy roidectomized pigs.

We have not found any other description of endemic goitre in
animals. We were very much pleased, therefore, when Professor
Grassi gave us a small Valtellina dog that presented several char-
acteristics of cretinism. The study of this dog forms the subject
of our paper.

We present here a study of cretinism in the dog, including a re-
search into the anatomo-pathology of the affection. As the pres-
ent knowledge is incomplete, all additional research into the
anatomo-pathology of endemic cretinism is most valuable, particu-
larly because up to the present the published autopsies of such
cases are altogether incomplete. In this paper we present an ab-
breviated clinical history of the dog and particularly the anatomo-
pathology of its thyroid gland.

The, dog is a small male subject, born in Berbenno (Valtellina), mon-
grel. In the Alps the variety of dogs to which ours belongs are generally
smaller than elsewhere. Our dog was about six months old when we
examined it. Its father and mother are afflicted with goitre. The peasant
who has taken care of the animal since its birth tells us that it is one of
three born the same day; one of these died immediately after birth, one
seemed to have been normal, except that it was of small size, homely ap-
pearance and weak physically; our dog was also of smaller size than usual
at birth, homely in appearance and weak physically ; it did not bark and
could not nurse ; it was nursed artificially with bread and milk during a
period of three months. It is difficult to give a detailed description of the
dog's condition during those three months. When about three months
old the animal was handed over to Professor Grassi's collaborator, Dr.
Munaron. According to his statement, the dog was then in a condition
of physiologic misery, its goitre was marked, the animal could not walk
and its somatic development was about half the normal. The bad con-
ditions in which the animal had been brought up may also have had some-
thing to do with its miserable state. The animal weighed 950 grams.
In this condition it was transported to Rome, where it began to take
nourishment itself, although still showing little appetite for food and
eating only chosen morsels. Nevertheless physical improvement took
place within a short time. The animal became more animated, ate more
readily of its own accord and grew considerably bigger in size ; a few

CRETIN DOG. ITS THYROID APPARATUS.— Dhs. Cereetti and Perusxni. 2II

months later it began to walk, but still preferred to remain in its corner.
When handed over to us it weighed 1,080 grams ; its length from fore-
head to end of tail was 31 centimeters. Its fur -was in black and white
patches, irregularly distributed; it was long and curly on the head, long
and thick on the cheeks. The ears were long and pointed, but flabby
and hung down. The fur on the ears was quite thick. On the trunk of the
body the fur was rather short, fine and thin; here and there were tufts
of fine but thin fur. On the limbs the fur was unusually long, especially
on the paws and between the toes, where it reached from 2 to 3 centime-
ters in length. There was also a long tuft of fur at the penis; the latter
was oval shaped, as is usual in small dogs. The head seemed large in
proportion to the body; the forehead was noticeably protruding, as in
Japanese dogs ; the nose was short, flat and flabby, the eyes wide apart so
that the external corners of the orbits extended beyond the temples on
both sides. The teeth were small, irregular but white. At the neck, an-
teriorly, two tumefactions were readily felt by palpation, each being the
size of a small hen's egg; each mass was movable, hard, but elastic to the
touch. The entire lumbo-saeral part of the spinal column was curved, the
concavity turned ventrally. The tail always hung down and was curved
between the posterior limbs. The left anterior limb was held in a nor-
mal position while the joint of the right one, corresponding to the elbow
joint, was turned outward, so that the sole of the paw was turned out-
ward. All the limbs presented permanent contractures; it was impossible
to extend them by passive movements, although the paws could be flexed
on the shin bones ; active movements were limited to movements of the
limbs in toto. The thighs of the posterior limbs were spread apart, the
joints corresponding to the knees turned outward and the legs turned in-
ward, so that when the animal was at rest one or both legs were turned
under its abdomen. Both these limbs presented marked resistance to
passive movements. The dog always sought to lie down. When made
to stand up the following conditions prevailed: the joints correspond-
ing to the knees of the posterior limbs as well as the paws were turned
outward, the legs presented spastic contractures with continuous tremors.
We had great difficulty in making the animal walk. In walking it used
mostly the left anterior and right posterior limbs; the other two limbs
remained stiff and were used only to maintain the equilibrium of the
body. In its usual attempts to walk the animal held its posterior limbs
crossed under itself, but now and then these limbs were straightened.
The right anterior limb was always turned inward, toward the middle
line of the body, and always remained in a condition of contraction. The
left anterior limb was in a fairly good condition and used mostly in gait.
When walking the animal's tail turned irregularly in all directions. When
forced to walk the dog took a few steps, always in the direction of some
corner in the room, and lay down. During such an exertion the dog
growled continually in a peculiar plaintive manner. Our animal also pre-
sented divergent strabismus, the right eyelid opened wider on the tem-
poral than on the nasal side, and the pupils reacted to light but very
slowly; the knee reflexes were exaggerated; sensibility to pain seemed to
be intact in the entire body. The dog always remained quiet in its corner
and never barked. When anybody came near, it lifted up its head, pricked
up its ears and looked with its eyes wide open, while its nostrils vibrated
Tapidly. Its hearing seemed to be intact because sounds and noises always
seemed to arouse it from its torpor. In its choice of food it always

212 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. s-

showed preference for milk and dainty morsels. It always urinated under
itself and without standing up. When handled somewhat roughly it
howled most piteously. It was difficult to ascertain whether or not it
recognized the different people who were in a habit of seeing it daily.

Autopsy. — The animal was killed by bleeding. In front of the
trachea and below it as well as at the level of the cricoid cartilage
was a large oval-shaped body about the size of a pigeon's egg; the
body was directed obliquely to the left and about five centimetres
downward. The trachea was flattened antero-posteriorly. The
mass was easily detached by cutting a few loose connective tissue
bands that held it in place. It was rich in blood vessels. The
veins were of large calibre and the arteries, also of large size,
entered the thyroid body in its upper part. On the right of the
trachea was another thyroid body but of smaller size than that
on the left side. The trachea was tilted toward the left side. In-
feriorly the gland was exactly between the trachea and the carotid
artery. The first thyroid body weighed 5.93 grams and the sec-
ond— 5.48 grams. The parathyroid bodies were normal in appear-
ance.

Both frontal bumps were considerably developed. The menin-
ges, pituitary body and spinal cord seemed to be normal. The
heart, large vessels, lungs and upper part of the gastro-intestinal
tract seemed to be normal. The walls of the small intestine were
quite thick, the peritoneum transparent and there was a large
amount of fat in the omentum, the fat running along the course
of the blood vessels. The spleen was thin and tabulated and the
liver seemed to be normal. The gall bladder was, very large, ad-
herent by its walls to the liver and filled with fluid of a deep blue
color. Both kidneys were smooth, of equal size and the capsules
were not adherent. The medullary substance was anemic (cause
— mode of death). The walls of the bladder were very thick.
The testicles were normal.

Microscopic Examination of the Thyroid Glands. — Fixa-
tives used: alcohol — 96 per cent, and 10% solution of formol.
Sections made by freezing process. Inclusion — with colloidin —
and paraffin. Control sections made on four normal dogs of about
the same size as our cretin dog. There was no essential difference
of structure between the right and left thyroid glands examined.

The fibro-elastic envelope of the gland was quite rich in elastic
fibres (Weigert's method) and sprang from the envelope itself.
The connective tissue envelope was thickened in toto and besides
presented numerous thickened bands ; in some places could be seen
the fibrillary tissue of the proliferated connective tissue ( Weigert's
method for the mitoses and hematoxylin of Heidenhain).

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 2IJ

Tissues of two different natures are found in section of the
gland taken along both its large and small axis ; these tissues are
particularly noticeable in the middle part of the gland. Here and
there are seen very large follicles intermixed with small ones.
The interstitial connective tissue is not very much developed un-
less it be in the principal tufts (Fig. 4). Near the tufts there are
patches here and there (more numerous at the periphery), in
which the medium size of the follicles is small and the interstitial
connective tissue is quite developed in all the tufts (Fig. 1). This
unusually thick network of connective tissue circumscribes lobules
that contain from 10 to 20 small follicles.

The thicker tufts of connective tissue do not ,show any clear
fibrillary structure but are made up of homogeneous bundles that
do not take any stain and seldom have any nucleus. These char-
acteristics would indicate that the connective tissue has undergone
hyaline degeneration (Van Gieson's stain).

The gland presents some normal tissue, but its greater part is
formed by the two kinds of tissue mentioned above.

Under a higher power one sometimes finds, especially in the
follicles surrounded by the thick network of proliferated connec-
tive tissue, regressive alterations of the epithelial cells. The con-
tour of the cellular bodies is not clear and some of the nuclei seem
to be outside of the cells, or without any cells. In some places
the epithelial layers themselves are most irregular. The epithelial
degeneration is also expressed by an abnormal size of the nuclei
that measure sometimes from 8 to 10 times the normal. Their
form is roughly round, their protoplasm pale and of ill defined
contour. Their weak affinity with hematoxylin prevents the study
of the distribution of the chromatin.

Among groups of more or less normal cells there are follicles
with pale and shrivelled cells that have smaller nuclei than normal,
highly colored and irregular (Fig. 2). Sometimes these elements
are grouped so that their .surface resembles that formed by a
tangential cut of an epithelial layer.

Within the follicles that present the above mentioned altera-
tions there can sometimes be found groups of polynuclear leu-
kocytes. In this rather rare case the follicles may be found almost
totally devoid of their epithelial lining, so that at times it is diffi-
cult to determine whether it is a follicle or a lymphatic fissure
more or less filled with colloid substance or one resembling it;
finally it may be taken for a vein clogged with coagulated plasma

(Fig-3)-

The majority of the follicles of the gland are clogged with col-
loid matter. Some parts of the gland are free from this sub-

214 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

stance, but it is impossible to ascertain the relation between this
condition, the size of the follicles and the degree of the epithelial
degeneration. On the other hand, the fixatives may considerably
alter the appearance of the colloid substance.

In sections of the gland treated with formol retraction of the
colloid substance in the epithelial walls is almost exceptional ; this
is common, or even marked, in sections of pieces treated with al-
cohol, showing plainly the characteristic processes and concavities
on the free borders. In this case the colloid substance is gener-
ally detached on one side only of the follicle. This detached col-
loid is less susceptible to the strain than is that adhering to the
epithelium. Besides, under artificial light the detached side of the
colloid substance has a granular aspect while that on the other
side is more homogeneous, compact and more readily stained*
These traits are constant in all our sections treated with alcohol ;
in the colloid substance of various follicles and even in that of. the
same follicle we found : I, homogeneity of the colloid adhering to
the epithelium with normal or exaggerated susceptibility to stain ;
2, granular colloid substance, retraction of the colloid from the
epithelium, bad stain or even absence of it.

Generally the sections treated with formol, as well as those
treated with alcohol, present a great variety of degrees of reaction,
to staining reagents, beginning with the follicle, the colloid of
which remains absolutely colorless, to the follicles the colloid of
which is highly stained. With Heidenhain's hematoxylin the col-
loid of the majority of the follicles is stained a dirty gray yellow ;
but the colloid substance of other follicles, especially that on the
periphery of the gland, is stained a dark steel gray and at times
black. Excluding all possibility of insufficient differentiation,
about the same results are obtained, with Weigert's method, for
the metoses and elastic fibres. Here we found an extraordinary
resistance of the colloid of certain follicles to decoloration even
after 20 hours' treatment with acidulated alcohol. When a double
stain is used the diffuse stain, such as eosin, is preferable for the
colloid substance ; in these sections the colloid can be found with
all degrees of the stain, from a pale pink to a dark red. This
stain is to be found, however, in two different chromatic varieties :
one in various degrees of pink or red, the other — in violet; in
either case there is a trace of blue (hematoxylin). Vassale's and
Brazza^ method (35 bis) give the same results with the colloid
substance, although the orange yellow stain is diffuse and the dif-
ferent hues not well marked because of the alcohol used a& a fixa-
tive instead of the direct stain with the reagent. With van Gie-
son's method the follicles are colored yellow (picric acid), or

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 2I5

orange yellow with other stains and finally red (fuchsin). About
a similar irregularity of reaction is obtained with van Gieson's
method modified by Weigert (36).

There is a relative absence of blood vessels in the gland. The
large arteries and veins are filled with blood, while the smaller
vessels and capillaries are empty. We do not wish to affirm that
we have seen within these vessels any substance similar to the col-
loid. In the very large fissure shaped lacunas and in the connec-
tive tissue tufts of the gland we found quite frequently a subr
stance resembling the colloid of the follicles as well as polynuclear
leukocytes.

The stain with Sudan III. and Flemming's fixative authorizes
us to exclude the supposition of the presence of fatty or similar
substances.

In the lumen of an artery of large calibre (corresponding to
the middle thyroid artery of man) we found eminences corre-
sponding to Schmidt's Arterienknospen (35). The artery was
one with predominance of elastic tissue in its tunica media.
Within the lumen there were two eminences, each facing the
other, and that could be seen with a low power (Fig, 5), The
external eminence was the smaller, formed by the intima and dis-
tinctly divided from the tunica media by the internal elastic
tunica. The intima shows a gradual thickening, forming a nipple
shaped eminence with a large basis. The endothelium apparently
participates in the proliferation of the connective tissue. Within
the thickness of the eminence there are a number of star shaped
cells, very little fibrillary substance, round cells and polynuclear
leukocytes, especially on the surface. Upon the internal elastic
membrane, within the thickness of the eminence, there is a rich
mass of proliferation connective tissue very poor in nuclei. In a
word, the eminence is formed partly by multicellular infiltration
and partly by fibrillary substance. We found these characterisr
tics in all the series of our sections.

The other eminence within the lumen is large, appears as a pe-
diculated mass, the peduncle being rather slender. All the layers
of the vessel are compressed in this button shaped eminence. The
depression of the external vascular wall, corresponding to the
peduncle, carries with it the perivascular tissue, and on a trans-
verse section of the adventitia of the border of this depression
are found small vessels, nerves and probably also veins. The
layer of elastic tissue is not interrupted at the acute angle of the
peduncle of the eminence, but continues although it is quite thin;
and according to the type of the blood vessel, its tunica media is
rich in elastic fibres ; but the great abundance of this tissue sug-

2i6 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

gests the question of its possible neoformation. At the head of
the eminence the endothelial layer is doubled and forms a cres-
cent shape, while in the rest of this mass the thickening is formed
at the expense of the adventitia and partly at that of the tunica
media, the intima showing no alterations. This crescent appears
to be formed mostly by the intima and also by the tunica media.

The deepest part (stained bright red with van Gieson-Weigert's
method) is very poor in nuclei and shows no evidence of any
fibrillary structure ; it appears like the hyaline degeneration of
connective tissue.

Within the vessel were still other eminences of smaller size but.
of the type similar to that described. All of them may be consid-
ered in three groups' i, small eminences with wide bases formed
by the intima only ; 2, larger button shaped eminences, almost
pediculated, formed almost exclusively by vascular tissue includ-
ing the adventitia; 3, small eminences growing from the second
variety formed by the intima and tunica media.

The alterations of this thyroid gland may be brought under
several headings. The rare morphologic modifications of the
epithelial layer of the follicles are rather of regressive nature.
Above all we should exclude here the question of parenchymatous
hypertrophy. While small follicles are found in groups here and
there in the different parts of the gland, we do not attach any
importance to their size in the sense of its being indicative -of
proliferation: up to the present the size of the follicles in the
thyroid gland has not been sufficiently studied to allow of any
conclusions on this score. Small follicles are quite numerous even
in normal thyroid glands of dogs, and, besides, reduction in size
of the follicles may also be an artifact caused by the reagents
used. Guerrieri (15) draws attention to the fact that when alco-
hol is used as a fixative of the thyroid substance the hardening is
excessive. Liibke (25) also drew attention to similar artifacts
caused by the fixatives used, the "Colloidzellen" of Langendorfr
(23) and of other authors are also some of the artifacts in ques-
tion. De Quervain (8) has made some interesting experiments
in this line with various fixatives. Unfortunately it is difficult
to obtain sufficiently thin sections with the freezing process with-
out using formol as a preliminary fixative. Nevertheless we
notice that the artifacts are infinitely less frequent when a 4%
solution of formol (formalin 10%) is used instead of a 90%
or even 70% solution of alcohol. Schmaus (32), Schmaus and
Albrecht (33) and Schmaus and Bohm (34) have shown that
after passing through the hardening process normal liver tissue

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 2I7

presented two layers of different aspects : one peripheral and the
other central; these were caused by the unequal action of the
fixatives. A similar condition is observed in the thyroid gland:
the peripheral follicles are smaller while the central ones are
larger and more regular. This is more marked when alcohol is
used as a fixative than when formol is employed. This fact made
us discard M-elle Geztowa's (13) method of using alcohol as a
fixative, with the exception of three instances mentioned in the
appendix. The non-use of alcohol was also convenient in regard
to the study of the fatty matter of the gland.

Besides the small sized and irregular follicles due to artifacts
in our case there were some that could be considered as the result
of a pathologic process-hyperplasia. The diagnosis of parenchy-
matous hyperplasia (Wirchow) of the follicles of the gland is
based on this characteristic.

Even in the normal thyroid gland of dogs one can find in sec-
tions over 20 mm. thick follicles apparently filled with cells. This
is caused by the direction of the plane of section ; we could verify
this fact by appropriate serial sections.

In our case we can exclude, therefore, the question of epithelial
proliferation. The majority of the follicles, both large and small,
are lined with cubic epithelial cells of normal aspect. There are
follicles of medium size, however, that are lined with flat cells,
but they are not filled with colloid substance. De Ouervain's
indications (1, flat celled follicle — filled with colloid; 2, cubic
celled follicle — medium quantity of colloid ; 3, cylindrical celled
follicles — absence of colloid) were not always verified in our
case. In some follicles with flat cells, oval, reniform and irregular
nucleus, the colloid substance was considerably reduced ; in other
instances the follicle was almost wholly deprived of epithelium
or nearly so, so that it was difficult to know whether it was a
follicle, a lymphatic fissure or a vein. It is probable that this
appearance expresses an extreme degree of atrophic epithelial
degeneration of the follicle. In such instances the cubic epithel-
ium has an irregular highly stained nucleus (Figs. 2, 3). In
some sections of this kind we found among these elements poly-
nuclear leukocytes (Fig. 3), and for this reason have asked
whether the cubic or round cells as well as the leukocytes were
not elements of an exudation. It also occurred to us that these
elements might be epithelial cells in process of absorption and
that had been impaired during a process of atrophic epithelial
degeneration. Properly speaking the high stain with hematoxylin
does not speak in favor of a degenerative process, but the marked
irregularity of the nucleus leads us to this supposition. Besides

2l8 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

the regular distribution of these cells and their resemblance to
the normal epithelial elements leads us to suppose that they were
undergoing degeneration. The description of these elements by
various authors also lacks certainty. Thus, Horsley (19) de-
scribes nuclear elements together with leukocytes that may be
found in the veins; Schmidt finds them identical with epithelial
cells, but is not certain whether they are ante- or post-mortem
formations; and M-lle Geztowa asks whether these elements are
not swollen cells of the vascular endothelium.

It cannot be denied that the epithelial elements here are pre-
sented in various phasesi of a true degenerative process, both
within the follicular cavity and the connective tissue. The uniform
stain of the protoplasm with eosin speaks in favor of this.

Of the atrophic phases found in the gland or its connective tis-
sue the most salient degenerative characteristic is the large follicle
filled with colloid substance, that presents in most instances two or
more follicles in one by reason of the breaking down of their walls
(Fig. 4). There can be no question of artifacts in this connection.

The interpretation of the various aspects of the colloid sub-
stance is rather difficult. Commenting on the normal colloid, so
far as it was known in literature up to 1901, Eiselsberg (12)
makes general conclusions on the mode of refraction and other
specific physical properties of the substance, but these have no
direct practical significance. Liibke finds that all fixatives produce
a constant alteration of the colloid and make it difficult to deter- .
mine microscopically whether it is solid or more or less fluid
matter. De Quervain has tried to determine the reactions of the
colloid to different stains. Anderson (2) has grouped the colloid
as chromophile and chromophobe. De Quervain does not accept
the simple distinction of the colloid according to its reaction or
non-reaction to stains, but advises to seek a finer differentiation
according to the quality of reaction. Accordingly he distinguishes :
1, colloid substance reacting slightly to stains, of granular and
thready aspect that should be considered as fluid ; 2, homogeneous
colloid readily taking the eosin and picric acid stain ; this variety
is normal colloid ; 3, colloid readily taking the hematoxylin stain,
and with van Gieson's the fuchsin stain ; this is solid and very
concentratetd colloid*

In our own researches we find that colloid of granular aspect,
not only in different but even in the same follicles, takes the
stain less readily ; and as this variety of colloid is always found
detached from the epithelial wall, as against the homogeneous

* De Coulon (7) thinks that this intense blue stain indicates a muci-
laginous transformation of the colloid substance.

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 2I9

colloid, the fact seems to favor De Quervain's opinion that the
granular colloid is fluid. We point this out as simple physical
characteristics, but do not agree with De Quervain that they
always express chemical differentiation. We cannot agree with
t>e Quervain's opinion just cited because the special predilection
for stain varies with the reagent used. Thus, predilection of the
colloid substance for hematoxylin was much more marked in
specimens treated with alcohol than in those treated with formol.
For this reason we cannot admit that variation of reaction should
"be taken always as an index of chemical differentiation of the
colloid in the follicles.

It may be useful to remark that the colloid of normal thyroid
tissue treated with alcohol is almost uniformly stained pink red
with eosin, while this was not the case in the gland here examined.
Sections without any chromatic affinity were exceptional in this
research. This leads us to suppose that the colloid in our case
differed from that of the normal thyroid.

We agree with Hanig (16), Ehrich (n) and Liibke that the
substance resembling colloid, found in the vessels and lymphatic
fissures, is most probably lymphatic plasma. We admit, according
to the present anatomic and physiologic knowledge, that probably
the latter contains some colloid substance in solution. Further
reason why this substance is nearer lymphatic plasma than follicu-
lar colloid seems to us to be the fact that we always found in its
masses migratory elements (leukocytes), whereas this was an
exception in the follicles, and especially in those undergoing
marked regressive epithelial and colloid alterations. We also
found in the veins and even in the arteries a substance resembling
colloid. In such instances we often found associated with it some
leukocytes. One need only examine other tissue than the thyroid
to become convinced that this substance in the veins and arteries
is nothing but plasma of coagulated blood; We do not know on
what ground M-elle Zielinska (38) supposes that this substance
is colloid.

We wish to say a few words on the blood vessels of the thy-
roid gland here examined. The button shaped eminences in the
arteries of the thyroid (goitre) were described for the first time
by Home (18), then by Schmidt in the normal gland. The
results obtained by the latter author are particularly interesting
because his researches were made both on cats and dogs. The
principal points of interest are : the localization of these eminences
at the point of bifurcation of the vessel and their accumulation
in a large number in the same vessel. Schmidt points out two

220 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

varieties of these eminences : one formed by the endothelium and
the other — both by the endothelium and the tunica media, the
button shaped eminences sending offshoots into the adventitia.
Some of these growths are covered by flat cells. Schmidt thinks
the latter are endothelial cells raised up by sub-endothelial pro-
liferation, derived, perhaps, from the internal muscular fibres. He
supposes in the end, however, that these growths may be formed
by the endothelium only, the superficial cells of which are altered
by the changed blood pressure. Geztowa does not accept this
opinion, ascribing the eminences to the changed blood pressure.
The conclusion that the growth is always of endothelial origin
is based on the results obtained with Weigert's stain for elastic
fibres. Geztowa says that if the endothelial growth wers formed
by proliferation of the muscular fibres of the tunica media it would
raise also the tunica elastica, whereas she has always found the
elastic tissue at the base of the eminence intact both in its structure
and direction of its fibres. Besides, she adds, the tunica media is
often irregular in thickness and sometimes absent even in normal
arteries in their entire circumference, so that the intima and
adventitia touch each other.

We think that Geztowa's arguments based on the stain of the
elastic fibres do not settle the question, as she herself finds emi-
nences containing elastic fibres of irregular direction ; but in
order to eliminate Schmidt's interpretation she claims to have
found the tunica media under the eminence intact and limits her-
self to the discussion of neoformation of the tunica elastica akin to
that found in arterio-sclerosis. According to de Coulon, oblitera-
tion of the lumen of the large vessels is caused originally by
unilateral thickening of the vascular wall, by a sort of polypiform
growths, that may reach out to the opposite wall of the vessel.
Geztowa accepts this view, basing her opinion on her study of
the connective tissue envelopes of the gland. She claims to have
followed out the process of total occlusion of the lumen from the
stage of simple intravascular button shaped eminence to that of
total occlusion and even total hyalin degeneration, reaffirming the
unilateral formation of the eminence, said to grow gradually until
it reaches the opposite side of the vascular wall until it joins it.

Geztowa gives the following differentiation between the emi-
nences in the large and small vessels respectively:

1. In the large vessels they are not localized at the point of
bifurcation, as is the case in the small ones.

2. Complete obliteration of the lumen takes place in the large
vessels but not in the small ones.

.3. In the large vessels the tunica media always remains intact.

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 22I

This is due to the difference of blood pressure in the large and
small vessels respectively, — persisting in the small ones, but be-
coming completely obliterated in the large ones.

4. Finally, these growths in the large vessels have a tendency
to hyalin degeneration.

We have quoted at length because the points brought out have
a bearing on our case. We wish to consider one more detail.
De Coulon speaks of thickening of the intima of the large vessels.
Schmidt and Geztowa do not seem to differentiate between the
intima and endothelial lining. Schmidt says that according to
Home the eminences spring from the endothelial lining, and
Geztowa thinks they spring from the intima. We think that
an anatomical error is the cause of the controversy we have re-
lated.

The eminences, it should be remembered, are found in the
arteries only. If we should take the arteries of the extremities
as a type of large arteries, the thyroid arteries are only of small
size in comparison. According to our present knowledge of the
structure of arterial walls, the endothelial lining and the tunica
elasdca are separated by a layer of connective tissue. Hence, a
morbid process localized at the intima involves not only the en-
dothelial lining but also the layer of connective tissue. We think,
for this reason, that the stellate cells, intermixed with the fibril-
lary substance of new formation that we found in the eminences,
are essentially of connective tissue origin. And as the thyroid
arteries are classed as being of small size, it is essential to deter-
mine where the connective tissue layer ceases to accompany the
endothelial layer. Diirck (9, 10) speaks of an intima represented
only by the endothelial lining in the precapillary arteries, but we
consider it arbitrary to deny the presence of a connective tissue
layer in the arteries in general ; Geztowa does not consider this
point at all in the plates of her work. It seems to us that she
falls into an anatomic error when she speaks indifferently of the
endothelial lining and the intima, and considers, with de Coulon,
the intima in large vessels and the endothelial lining only in the
small ones. We ask, then, on what ground does she deny the
existence of the connective tissue layer in the small vessels and
why does she not point out the difference between the pathologic
processes that should take place in the endothelial lining in one
case and in the intima in the other?

The intra-arterial eminences we have observed were all within
arteries of medium size. But the large eminences do not seem to
us to correspond to those described by de Coulon, for the advan-
titia always formed part of the growths. We neither affirm nor

222 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5-

deny that the small nipple shaped eminences represented prelim-
inary stages of development of the larger ones. The intima is
involved, and there is no basis for differentiating it from the
process of common endarteritis. We prefer, with Amaldi (i),
to speak with reserve on the question, as it is generally admitted
that on the one hand the thyroid lesions are of endarteritic
nature, and on the other Amaldi has so often found endarteritic
lesions in the thyroid; under these conditions we consider it pru-
dent to defer our definite conclusions. We call attention to the
fact, however, that one should not mistake for a pathologic growth
the folds of a shrunken artery or the misleading aspect of the
surface of an oblique section of an artery made at the point of
its bifurcation.*

A few words more about the anatomo-pathologic process of
the growths here considered. According to Schmaus (31), the
term parenchymatous goitre should be applied to the enlarged
gland with dilated follicles that are increased in number ; and
colloid goitre — when the enlargement is caused principally by
hyperproduction of the colloid substance that causes dilatation of
the follicles. This variety may end, through an atrophic process,
in cystic goitre. Kauffmann (20) speaks of fibrous goitre caused
by proliferation of fibrous tissue. According to Ribbert (28)
this is a common process. In our case the diagnosis of colloid
goitre seems to be proper, regardless of the fact that we found
here and there signs of regressive follicular atrophy and marked
thickening of the connective tissue tufts.

We recognize that our diagnosis does not explain the anatomo-
pathologic process. For, in the thyroid gland, as elsewhere, a
hypertrophic process may include at the same time an atrophic one
(30). Bircher (4) clearly treats of this question when explaining
the onset of an interstitial inflammation of the thyroid subsequent
to a parenchymatous one.

This transition from one process to another explains Geztowa's
statements : from the study of thyroid glands she has examined
(5 cretins, 5 congenital idiots and 1 microcephalic subject) she
finds that the 4 atrophic glands of the cretins and the 2 of the

* After having demonstrated that these growths were not artifacts
Schmidt declared that they had nothing in common with arteriosclerosis
because they were found in normal glands, in those of the new-born, and
in those subject to arteriosclerosis their number was not higher than in
other cases. He thinks that these formations probably take place before
or after birth without attracting attention in any way. Their formation
has nothing to do with the thyroid function or the formation of colloid
substance. Geztowa accepts this view on the ground of her study of
thyroid glands with impaired or abolished function. We wish to remark,
however, that it would be interesting to know how many of these growths
existed before the onset of the atrophic process.

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 223

idiots presented marked resemblances with the only atrophic gland
of the series (3-d idiotic subject).

Bircher asks whether all the anatomic tables of goitre do not
express the same morbid process. We push the question further
and ask whether those tables do not express different stages of
the same pathologic process, and what is the succession of these
stages in endemic goitre?

There seems to be no doubt that between colloid and fibrous
goitre, the latter is a sequence of the former, as fibrous degenera-
tion is always a terminal stage. Nevertheless we do not know
the evolution of this process step by step. The majority of authors
compare the process of fibrous degeneration to senile sclerosis of
the gland. Bircher speaks of its atrophy as a consequence of
inflammation. We are inclined to accept this view, although the
pathogenesis of this slow chronic inflammation remains unex-
plained.

Is colloid goitre always preceded by parenchymatous
goitre? Although the question is of great interest we have no
systematic researches in this direction. And does endemic goitre
always begin as parenchymatous goitre ?

Some authors answer the latter question in the affirmative.
According to Grassi and Munaron (14), who took up the question
of insufficient organic iodine in the atmosphere as a cause of
goitre, the changes in the gland are caused by hyperf unc-
tion (parenchymatous hyperplasia). The hyperproduction of
colloid substance is considered as a natural consequence; hence
the term colloid goitre. This hypertrophy is said to be intended
to provide for a greater production of colloid substance (in pro-
portion to iodothyrin) to make up for the insufficiency of organic
iodin in the organism.

Even admitting that endemic goitre commences with parenchy-
matous hyperplasia, this hyperplasia is not found to be the salient
point of endemic goitre so that it could be distinguished from
other thyroid hyperplasias. The same pathologic picture is indeed
found in Basedow's disease and in other affections of the thyroid
gland. We think that the differential trait between endemic goitre
and Basedow's disease is that in endemic goitre the colloid sub-
stance accumulates in the follicles, whereas in Basedow's disease
this substance is reduced to an abnormal degree. The most strik-
ing characteristic of endemic goitre is not epithelial hyperplasia
but retention of the colloid substance.

Putting aside all hypothesis, does the large quantity of colloid
substance in the follicles of goitrous subjects really indicate
glandular hyperfunction ?

224 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

We know so little about the function of this gland that it is
hazardous to draw conclusions on it on the basis of microscopic
findings. Nevertheless, clinical and experimental knowledge leads
to the belief that hyperfunction of the thyroid is not a character-
istic trait of colloid goitre. In Basedow's disease, on the contrary,
there seems to be a condition of hyperthyroidism, and the colloid
substance is almost wanting in the gland. At all events, if the
fact admitted today is true that the colloid substance is thrown
into the circulation, it would be of interest to learn why this
needed colloid substance remains accumulated in the follicles to
such an extent that their walls become atrophied from overdis-
tension ?

This question can be answered only by systematic researches
into goitre in man in its various stages of development. Grassi
and Munaron have indicated the right direction in which such
experiments should be made.

Endemic goitre is almost always accompanied by symptoms of
more or less marked hypothyroidism; but it is generally admitted
that colloid goitre is compatible with normal life of the subject.
The study of our cretin dog shows that it did not differ function-
ally from subjects afflicted with colloid goitre, such as is found
among subjects in endemic countries.

Bircher, 1896, and Langhaus (24) suppose that in cretins parts
of the gland are respected; Kocher (21, 22) believed that as long
as part of the thyroid body remained intact cretinism was not a
necessary sequence. We do not agree with these authors that so
complicated a syndrome as cretinism is should depend solely on
the alteration of the thyroid gland, although facts force us to
admit an intimate relation between the state of the gland and
cretinism. Yet the overwhelming pathologic changes in endemic
cretins do not always seem to be explainable by the state of the
thyroid gland exclusively. In another paper (5) we considered
the question of the cause of endemic cretinism and showed that
this chronic disease was due to hypothyroidism that may be char-
acterized by periods of remission, according to the greater or
lesser demand on the thyroid function (period of life, develop-
ment, physiologic state, etc.). And if the thyroid gland of the
cretin presents relatively important, changes, the fact only con-
firms our theory on endemic cretinism (5, 6) ; we considered this
question at length and since 1904 we ascribe the disease not to
thyroid alterations exclusively but also to endemic hypothyroidism
of the mother during the nine months of pregnancy with her
offspring.

DRS, CERLETTI AND PERUSINI

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Fig 3

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JOURNAL OF MENTAL PATHOLOGY VOL. VII, N. 5

r '

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 225
EXPLANATION OF THE FIGURES.

Fig. I. Thickening of the connective tissue tufts. Alcohol.
Hematoxylin-eosin. Seibert. Ocular III., objective II.

In specimens represented in Figs, i, 2 and 3 the reaction to
eosin was almost nil.

Fig. 2. Endofollicular cells with small nuclei. Alcohol. Hem-
atoxylin-eosin. Seibert. Ocular I., objective — homogeneous
immersion, 1/12.

Fig. 3. Polynuclear leukocytes and cells with small nuclei in
follicles (or lymphatic fissures?) devoid of epithelial lining. Al-
cohol. Hematoxylin-eosin. Seibert. Ocular I., objective —
homogeneous immersion, 1/12.

Fig. 4. Colloid goitre — predominant alteration. Formol. Van
Gieson-Weigert. Seibert. Ocular III., objective II.

Fig. 5. Endothelial button shaped eminences. Formol. Van
Gieson-Weigert. Seibert. Ocular I., objective II.

Fig. 6. Section through the thickest part of the largest button
shaped eminence shown in Fig. 5. Seibert. Ocular I., objective
- — homogeneous immersion, 1/12. .-

REFERENCES.

i. Amaldi. La ghiandola tiroide negli alienati, Rivista speri-
mentale di freniatria, 1897, p. 31.

2. Anderson. Zur Kenntniss der Morphologie der Schild-
driise, Arch. f. A fiat, und Physiol., 1894.

3. Billiet and Morel. Influence de la constitution geo-
logique du sol sur la production du cretinisme, Paris, 1855.

4. Bircher. Fortfall und Anderung der Schilddrusenfunk-
tion als Krankheitsursache, Lubarsch-Ostertag Ergebnisse. I. Ab-
teilung, 1896, pp. 67-68.

5. Cerletti and Perusini. Studi sul cretinismo endemico.
Parte I., Annali del Istituto Psich. della R. Universita di Roma,
Vol. III., fasc. 2, 1904.

6. Cerletti and Perusini. Sopra alcuni caratteri descrittivi
antropologici nei soggetti colpiti dell' endemia gozzo-cretinica,
Annali del' Istituto Psich. della R. Universita di Roma, Vol. IV.,
1905.

7. De Coulon. Ueber Thyroidea und Hypophysis der Kre-
tinen sowie Thyreoidealreste bei Struma nodosa, Virchows Arch.
Bd. 147, 1897.

8. De Quervain. Die akute nicht eiterige Thyreoiditis, Jena,
1904.

9. Durck. Atlas und Grundriss der algemeinen patholog-
ischen Histologic Munchen, 1903, p. 370.

226 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

10. Durck. Atlas and Grundriss der specielen patholog-
ischen Histologic, Munchen, 1901, Bd. L, p. 18.

11. Ehrich. Klinische und anatomische Beitrage zur Kennt-
niss des Morbus Blasedowi, Beitr. z. Klinisch. Chiriur., Bd. 28,
1900, p. 97.

12. Von Eiselberg. Die Krankheiten der Schilddriise,
Deutsche Chirur, Lieferung 38, 1901.

13. Geztowa. Ueber die Thyreoidea von Kretinen und
Idioten, Vir chows Arch., 180, Bd., 1905, p. 51.

14. Grassie and Munaron. Uno sguardo alle nostre
ricerche sul gozzo e sul cretinismo endemico, Rendiconti della R.
Accidentia dei Lincei, May 7, 1905, p. 496.

15. Guerrieri. Azione del fosforo nella ghiandola tiroide,
Rivista sperimentale di freniatria, 1896, p. 462.

16. Haemig. Anatomische Untersuchungen ueber Morbus
Basedowi, Arch. f. klinisch. Chirur., LV., 1, 1897.

18. Horne. Cited by Amaldi, Lancet, Nov. 26, 1892.

19. Horsley. Remarks on the function of the thyroid gland.
A critical and historical review. British Med. Jour., p. 215, 1892.

20. Kauffmann. Lehrbuch der speciellen pathologischen
Anatomie, III., Auflage, Berlin, p. 299, 1904.

21. Kocher. Die Schilddrusenf unction im Lichte neuerer
Behandlungsmethoden verschiedener KropfTormen, Correspond-
ent. f. Schweizeraerzte, No. 1, 1895.

22. Kocher. Zur Verhutung des Cretinismus und cretinoider
Zustande nach neuer Forschungen, Deutsch. Zeitschr. f. Chirur.,
Bd. 34, 1892.

23. Langendorff. Beitrage zur Kenntniss der Schilddriise,
Arch. f. Anat. u. Physiol., 1889.

24. Langhans. Ueber Veranderungen den peripherischen
Nerven bei Cachexia thyreopriva des Menschen und Affen sowie
beim Cretinismus, Vir chows Arch., Bd. 128, p. 378, 1892.

25. Lubke. Beitrage zur Zenntniss der Schilddriise, Vir-
chows Arch., Bd. 167, H. III., 1902, pp. 490-532.

26. Moussu. Fonction thyroidienne. Cretinisme experimen-
tale chez le chat et les oiseaux, Soc. de biologie de Paris, Jan. 23,
1897, p. 82.

27. Raynard. Recueil de medecine veterinaire pratique,
1836, seconde series, t. V., p. 1.

28. Ribbert. Lehrbuch der pathologischen Histologic, II.
Aufl., Bonn, p. 365, 1901.

29. Saint Lager. Etude sur les causes du cretinisme et du
goitre endemique, Paris, Gailliere, 1867;

CRETIN DOG. ITS THYROID APPARATUS.— Drs. Cerletti and Perusini. 227

30. Schmaus. Zur anatomischen Analyse des Entziindungs-
begriifs Wisbaden, 1903.

31. Schmaus. Grundriss der pathologischen Anatomie, 7th
edition, Wiesbaden, p. 351, 1904.

32. Schmaus. Ueber Fixierungsbilder von Leberzellen im
normalen Zustande und bei Arsenikvergiftung, Centralb. f. alge-
meine Pathol, und pathologische Anat., Bd. XIV., 1903.

33. Schmaus and Albrecht. Zur funktionellen Struktur
der Leberzelle, Jena, 1899.

34. Schmaus and Bohm. Ueber einige Befunde in der Le-
ber bei experimenteller Phosphorvergiftung u. Strukturbilder von
Leberzellen, Vir 'chows Arch., Bd. 152, H. 2, 1898.

35. Schmidt. Ueber Zellknospen in den Arterien der Schild-
driise, Vir chows Arch., Bd. 137, H. 2, 1894, p. 330.

35. Vassale and Di Brazza. Nuovo metodo per la dimos-
trazione della sostanza colloide nei vasi limfatici della ghiandola
tiroide, Rivista sperimentale di freniatria, v. XX., 1894, p. 66.

36. Weigert. Eine kleine Verbesserung der Hematoxylin
van Gieson methode, Zeitschr. f. wissensch. Microspokie u. f.
mikrosk. Technik, Bd. 21, H. 1, 1904, p. 1.

37. Ziegler. Lehrbuch der speciellen pathol. Anatomic, 7th
edition, Jena, 1892, pp. 719-720.

38. Zielinska. Beitrage z. Kenntniss der normalen u. stru-
mbsen Schilddriise des Menschen u. des Hundes, Diss., Bern,
1894, and Virchows Arch., Bd. 136.

Rome, January, 1906.

fe <

THE GENESIS OF GENIUS.*

By LOUISE G. ROBINOVITCH, B. es L, M.D. (Paris),

Member, New York Academy of Medicine, Member, American Medical
Association, Foreign Associate Member, Medico-Psychological

Society, Paris.

General Considerations. — Geniuses and distinguished men
may be designated as beings born with potential energy of a
degree higher than is that of ordinary men. Carlyle's definition
of genius, — "the ability to take infinite pains," — quite corresponds
with reality from a scientific point of view. All great men have
been noted for so marked a capacity for work and sustained
thought that it is customary to wonder how they found it possible
to accomplish so much in the short period that constitutes a human
lifetime.

Whence comes such potential energy in man?

Has heredity any vital bearing on the birth of genius? If so,
how is one to explain the paradox of the coexistence of genius and
mediocrity or even of imbecility in the same family and of the
same parentage?

I know a large family in which the first-born are of mediocre
intelligence, while the youngest is a brilliant child. In another
family two of the offspring are of mediocre intelligence, devoid
of common accomplishments, while one, the youngest, is gifted
in many ways and well known for more than one accomplishment.
In another family, that I have known for years, there is the same
paradoxical line of demarkation separating moral imbecility of
one member of the family from splendid manhood and genius in
another. In still another family three of the offspring are
famous in the world of science and the arts, while one is an
imbecile. One could go on citing instances almost without limit.

* Read by title at the Second Belgian Congress of Neurology and
Psychiatrie, held at Brussels, August 29-31, 1906.

THE GENESIS OF GENIUS.— Dr. Robinovitch. 229

We have all exhausted our resources on theories of environment
and other determining factors in the genesis of crime and crim-
inality, and we probably all recognize that in reality something
more than mere incidentals must be looked for as factors in the
shaping of individual psyche. For we know that the environ-
ment which inevitably degrades one member of a family may
not only allow that member's brother to escape unscathed, but is
apt to prove the very basis for the upbuilding of a magnificent
manhood in the latter.

When we come across these stumbling blocks in the theory of
"environment," we readily add that predisposition together with
environment work for the good or for the evil of the respective
members of the same family. When dealing with criminality, we
readily confound poverty with criminal environment and base
our arguments! on that "environment" as being synonymous with
criminality in the case of the poor.

That the above argument is both correct and incorrect is self
evident: 1, it is correct in so far as bad influences favor the
development of the bad, who could otherwise pass in the crowd
of moral mediocrity; 2, it is incorrect in so far as some subjects,
who find themselves in the depths of degradation, draw from
those very depths the richest sources of inspiration for all that
is healthy and ideal. There is no dearth of types in classic liter-
ature illustrating sterling character that rises superior to "en-
vironment" of the mpst degrading nature at certain periods or
at specific epochs. In such cases the flash of character is due to
a supreme effort of a lifetime, — an effort that to be sustained
would require a more potent cellular potentiality than the de-
graded possess.

It should be borne in mind that what we call "right" is usually
done at the expense of privation, sacrifice and general control
that requires a great expenditure of energy. In real life it would
be difficult not to verify what has been typified in fiction.

The world's greatest men, with very few exceptions, were born
and bred and often died in poverty. In most instances very dung-
hills of immorality and hideousnesis served — not to degrade, — but
to elevate them to the most sublime heights of morality.

However meaning or meaningless the theory of environment
may be, we cling to it ; it suits our ideas more or less, and we
love it as an argument, leaving the term more or less to take care
of itself — so long as we are enabled by it to tide over a difficulty.
There are conditions, however, in which the trick contained in
the more or less kind of reasoning does not lend itself as an argu-
ment. Such is the case when honorable parents in favorable and

230 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

even ideal circumstances give birth to offspring vastly differing
from one another in morality, mentality and capacity. How is
one to explain the fact that the same parents, under the same
environments, gave birth to three offspring who are famous all
the world over, while one is an imbecile? I have a letter from
a New England lady who asks me a similar question about a fam-
ily quite similar to the one just mentioned, saying:

"How can you explain this shocking condition in the family
"X.," when the surroundings were certainly most ideal for all
the children, and the heredity was the same. Knowing your
views on the workings of alcoholism, I wish to add that the par-
ents of these children never touched liquor."

Another, and more common occurrence, is for a family to have
one member a genius while the rest of the offspring are of medi-
ocre mentality. Of this class of families there have been and are
as many as there have been and are geniuses, as may be seen
by examining biographies chosen hap-hazard, — Michael Angelo ;
Leonardo Da Vinci — the eldest of eleven children, his father
having married four wives in succession after the birth of Da
Vinci; Sir Joshua Reynolds — one of seven children; Prud'hon
(Pierre) — (the thirteenth child; Gainsborough (Thomas) — the
youngest son of a large family ; Schumann — the youngest of
five children ; Mozart — the youngest of seven children ; Wagner
— the third of seven children ; Schubert — thirteenth of fourteen
children ; Benjamin Franklin — youngest of seventeen children ;
Cooper (James Fenimore) — one of eleven children; Washing-
ton Irving — youngest of eleven children; Dickens — second of
eight children; George Eliot — fifth and youngest child; Cole-
ridge— youngest of a large family, and Napoleon, the eighth of
his family. Many more instances may be cited, showing that
great men, who must have had excellent heredity — in the sense
that will be explained here — had mediocre, or even worthless,
brothers and sisters, whom they often had to support.

What, then, is the significance of heredity in the light of the
above conditions? If heredity is excellent enough to produce
one genius, why should it be impotent as regards the brothers and
sisters of the genius ?

The answer to this question will be developed in this paper.
Meanwhile, it is of interest to call to mind once more what con-
stitutes genius. As has already been remarked, Carlyle's defini-
tion, according to which genius consists of the "ability to take
infinite pains" appears correct, and has the great merit of lending
itself to verification at all times. Translated into technical lan-
guage, the sum total that makes up intellect (memory, intelli-

THE GENESIS OF GENIUS.— Dr. Robinovitch. 231

gence, will-power, judgment, etc.) is, according to Dr. L. Lefe-
vre's definition (i) a function of the central nervous system
(p. 186). According to this author, the sum total of that which
constitutes intelligence (memory, will-power, judgment, etc.),
cannot be transmitted by parents to their offspring, because this
sum total is a function, and one does not inherit functions, but
organs that preside over them. We no more inherit from our
parents this sum total than we inherit from them secretion, respi-
ration or the circulation of the blood. We get from our parents
organs, — a cerebrum, kidneys, lungs, a heart, and — "like organ,
like function." We inherit not our gait, but limbs (p. 187). The
new born infant does not possess any will-power, judgment,
intelligence or conscious conception; at that age sensory impres-
sions,— the first sources of ideas, do not yet reach the organ of
thought, and the child has neither memory nor centres of realiza-
tion or exteriorization. It has neither sentiments, affections,
nor the senses of responsibility and remorse; the child possesses
nothing of intelligence, and lives a life of vegetation (p. 188).
Ideas are possible only where there are sensations, as the forma-
tion of ideas is always consecutive to sensations. It is finally
concluded that parents transmit to their offspring that which
exists virtually in the ovum — the various parts of the body and
the tendencies inherent to human nature, such as the sense of
preservation of self and of the human race. All else that is the
result of function is acquired with experience (p. 189).

Dr. Lefevre's conclusion seems to correspond with existing
facts, as will be further demonstrated. It follows, then, that when
we speak of genius it should not be presumed that a genius has
a higher mentality at birth than his brothers and sisters had or
will have, because mentality does; not exist at the time of birth.
Mentality, being the result of function, and a function not being
inheritable, as the above author justly remarks. Genius inherits
cellular potentiality as do all his brothers and sisters, but his
cellular potentiality is of a higher degree.

Take, for instance, the genesis of idiocy and imbecility. It has
been proven by many clinicians that alcoholism, syphilis and
various other pathologic factors in the parents are causes of these
diseases in the offspring. In my own papers on the subject I have
demonstrated that alcoholism of the parents isi the major cause
of idiocy and imfbecility of the offspring. (2). Clinical work
proves beyond any doubt that a perfectly healthy parent, if intoxi-
cated with alcohol at the time of conception of his offspring, is apt
to cause the birth of an idiotic, imbecilic, epileptic or otherwise
degenerate child. It is further worthy of note that the first chil-

232 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

dren of inebriate parents are apt to be less degenerate than the
last ones — when the parents' cellular potentiality has reached a
marked degree of reduction. This fact was particularly exempli-
fied in my paper on the genesis of epilepsy (3).

The mechanism of these workings in chronic alcoholism is quite
complex, but need not be considered here beyond the fact that
the cellular potentiality of the entire body of the alcoholic progeni-
tors is changed by virtue of the impaired organic function caused
by the pathogenic agent — alcohol. In the case oi chronic alco-
holism, for instance, the brain cells are the first affected physi-
ologically, and individual indiosyncrasies govern the successive
pathologic involvements of the other organs in general. In the
end, however, every tissue in the body is the sufferer — the brain,
the kidneys, the liver, the lungs, the ovaries, the testicles, the
circulation, and consequently, the entire body. Under these con-
ditions cellular potentiality is reduced, and a child born of such
parents1 pays the penalties of its progenitors' sins.

In acute cases similar conditions of reduced potentiality exist.
Alcoholic intoxication of the parents at the time oi conception
of the offspring disturbs the physiologic cellular status causing
a reduced cellular potentiality of the entire system — including
the ovule and the spermatozoid. Hence, a conception resulting
during such a state ends in the birth of an offspring with reduced
cellular potentiality, — in idiocy, in imbecility, in epilepsy, etc.

Of course, cellular potentiality may be changed by other agents.
Psychic conditions may also produce perturbed physiologic func-
tion and consequent detrimental nutritive changes. Strong
emotions have been known to turn one's hair gray in the course of
one night, as was the case with Marie Antoinette. And I know
certain subjects who have "spells of gray hair crops" when under
unusual mental stress, As soon as the mind is relieved from
anxiety, the crop of gray hair is replaced by hair of normal color.
That such conditions are due to perturbed physiologic function,
bio-chemical changes and reduction of cellular nutrition need not
be argued. We know that various conditions oi mental status
are characterized by various bio-chemical changes. In 1886, Dr.
Mary Putnam Jacobi (4) found in a woman suffering from incip-
ient melancholia and mental inactivity the excretion of urea
reduced to 14 or 15 grams daily, as against 20, 25, 28, 35 and 38
grams daily in normal women. That such bio-chemical reduction
goes hand in hand with lessened cellular potentiality need hardly
be argued. The importance of bio-chemistry in relation to psy-
chiatry and cerebration in normal people is being more and more
appreciated, and some important work is beinsr done on the

THE GENESIS OF GENIUS.— Dr. Robinovitch. 233

subject by various workers. Thus, dementia precox (whatever
significance clinicians may wish to attach to the term) is said to
be characterized by a marked decrease of urea and of uric acid
as well as by decreased acidity of the urine (5). Whatever
findings await us in the future in this new field of work, the
progress made in this line of research in relation to psychiatry
shows that not only the biochemistry, but also the cytology of
the blood changes with the various forms of psychoses. Whether
such changes are always caused by microbic agents need not be
discussed here. The fact remains that the function of mind is
intimately related to the function of body — and to that of the
millions and billions of its various constituent cellular elements.
Pleasure, pain, joy, grief, mental exhilaration or depression, — all
have their respective and characteristic physiologic, pathologic,
bio-chemical and even cytologic effects. From a physiologic
point of view these occurrences are quite natural, as emotion of
whatever kind feeds on energy, and expenditure of energy must
necessarily be based on certain combustions, involving either
reduction or destruction of certain cellular elements. Hence, it
is not to be wondered at that strong emotions of an extraordi-
narily sad character should turn the hair of a young person gray
in the course of one night, or that strong emotions of a pleasur-
able character should change one's usual sluggish cellular poten-
tiality into one of higher degree.

Effect of Cellular Potentiality of the Parents on the
Quality of Their Offspring. — Psychiatric research has fully
brought to light the relation existing between the status of the
parents at the time of conception of their offspring and the men-
tality of the latter. A good part of this subject is treated of in
my two papers already quoted. Similar study in relation to so
called normal people is still in its infancy, but analysis shows that
a similar correlation also exists in the latter case. Thus, I know
a f amity in which moral imbecility of the offspring is directly
traceable to marked anxiety and worry of the mother on the night
of marital relations that resulted in the conception, of which the
moral imbecile in question was the issue. The mother says that
she did not wish to marry, but was forced to do so by her parents.
She wept as she was being led to the altar. She says that her
eyes, nose and face were red and swollen from weeping. The
offspring in question was born nine months after the marriage.
He is a "moral imbecile," from a technical point of view, although
he has a certain position in the world in which he moves ; he has
congenital anosmia — -having never known the sense of smell. All
the other children are normal and moral.

234 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

There can be no doubt that the violent emotion experienced
by the mother at the time of conception of her first offspring was
directly responsible for the character of that offspring: the emo-
tion and grief caused perturbance of the metabolic process and
such a deep change of the cellular potentiality of the mother that
a pathologic offspring was the result of the union.

An extraneous poison, such as alcohol, morphine, cocaine, etc.,
taken in excess at such a time, could not have had a more potent
influence.

The proof that the above mentioned correlation between cause
and effect was a reality is almost demonstratable in the same
family. Thus, the mother is a woman of high morality of the
Puritan type; she is intelligent, tenacious and possesses a goodly
share of practical common sense. Armed with these qualities,
she lost no time in reconciling herself to her marriage, with the
result that she became convinced of the girlish folly of her hostile
attitude towards the man who proved to be a devoted husband.
In a stormy struggle with the stern realities of life that overtook
them both, she became a devoted wife and companion to her
husband. He showed himself worthy of her friendship as an
honorable husband and good father. Before the youngest child
was conceived, business compelled him to absent himself. During
that time the wife had continued proof of his sincerity, honor and
devotion. She was a happy wife when he finally returned. The
youngest child was born nine months after that return. The
child early showed remarkable gifts. He was precocious, early
became an omnivorous reader, wrote poetry when seven years
old, was a leader of his companions and dreamt childish dreams
of supremacy and grandeur. Supremacy and grandeur he at-
tained— not in a childish way, but as a distinguished man — at an
early age. His achievements are known wherever civilization is
known.

It cannot be denied that in view of the facts exposed, touching
on the correlation of cause and effect in the genesis of human
psyche, it would be wrong to deny such a correlation as was
presented here.

High Cellular Potentiality is the Heritage of Great
Men. — Such superior capacity for mental work, as this youngest
offspring exhibited is common to all great men. And almost all
such men are given life when their parents present the highest
degree of cellular potentiality.

In all ages genius has been characterized by an enormous
capacity for work and potential mental energy. This energy is
marked even when physical strength is below par, as was the

THE GENESIS OF GENIUS.— Dr. Robinovitch. 235

case with Demosthenes, Voltaire, Heine, Daniel Webster, Alex-
ander Pope, and many others.

Geniuses and the Ages of Their Progenitors. — How is one
to explain the fact that the same parents can hand down to their
different offspring different degrees of cellular potentiality ? The
question is most complex, as may be judged from the facts already
adduced. Many and varied factors preside over the hereditary
transmission of potential energy : they are physical, mental, physi-
ologic, pathologic, bio-chemical, etc., etc. Under these conditions
no fixed formula may be given without committing some grave
error. Nevertheless, a glance at the biographies of great men
shows one conspicuous feature as a factor in their birth — their
parents are, as a rule, not young.

An examination of a number of biographies shows that:

1. The majority of great men were not the issues of youthful
parents, and a very small minority only were first offspring.

2. The majority of great men were born when their parents
were nearer thirty years of age and above, than twenty or below.

3. The majority of great men were the youngest offspring, and
in some instances even the youngest offspring of the youngest
offspring, while only a small minority were firstlings.

4. In other words, parents who have reached the age of mature
cellular potentiality are most apt to give birth to great men and
geniuses.

5. Youthful parents seldom give birth to gifted children because
such parents have undeveloped systems with potential energy that
Is below par.

Prof. A. Marro concludes, from his research into criminality
in relation to the age of parents, that the frames and organs of
youthful parents are still draining the circulation for growth, and
individual cellular vigor is still below par. Children born of such
parents are apt to be degenerates. Similar results are observed
among the lower animals, the offspring being cachectic and rap-
idly succumbing to the effects of the slightest ailments (6), p. 2j6.

The reader is also referred to my paper entitled "The Genesis
of Sex" (7), in which the subject of the parents' age in relation
to the potential energy of the offspring is considered at length,
the subject practically being an introductory chapter to this paper.
The facts brought out in that paper, together with those here
treated, explain the apparently mysterious instances of the birth
of geniuses and mediocrities in the same families.

The Majority of Geniuses and Great Men Were the Off-
spring of Parents Mature in Age and Development. — In my

236 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

paper dealing with the genesis of sex, particular stress is laid on
the variation of potential energy of the mother, and it is demon-
strated indirectly that high mentality of nations goes hand in hand
with high cellular potentiality of parents. It is also demonstrated
that such high parental cellular potentiality is possible only when
mature age is reached, such as from 30 to 35 years for man, and
25 to 30 years for woman. The principle of procreation at the
age of maturity in relation to high civilization applies equally to
the genesis of genius : the higher the potential energy of the
parents at the time of conception of the offspring the more chance
is there for that offspring to become a genius.

Both the father's and mother's potential energy play important
roles in the heritage of the offspring. This fact is amply demon-
strated in every day life as well as in psychiatric work.

While considerable importance is ascribed here to parental
potentiality, it may be well to bear in mind that age alone — as an
index to potential energy of parents — should not be taken as an
absolute criterion in all cases. Thus, one or both parents may
happen to be in better or in worse condition irrespective of age,
accordingly transmitting to their offspring a high or low poten-
tiality. In a contemporary Imperial family, for instance, one of
the younger children is an imbecile, and an illegitimate child,
born of the same Imperial father and in the same year as the
imbecile prince, was deformed in exactly the same manner as
the Imperial progenitor. The eldest and other children of this
monarch are in good physical condition (I omit citing the source
of this information for obvious reasons).

Thus it is evident that a sheer statement of the fact that a
child was a first or a last born means nothing in itself, as a first
born may come into the world when the parents are at the age
of mature development. It is more important, therefore, to know
the age of the parents when a given child was born than it is to
know whether the child was a first or youngest child. This
information should, of course, be considered in connection with
a normal physical and mental status of the parents, otherwise the
results change.

Another point of interest in the study of the genesis of g'enius
is where the child is born outside of wedlock. This question is
too complex for consideration here, as it would require a lengthy
analysis in itself. Take, for instance, the case of Leonardo Da
Vinci, who was the oldest of eleven children, his father having
married four wives in succession after the birth of Da Vinci, the
illegitimate child. His father was twenty-five years old when the
great painter was born, but I have not been able to discover the

THE GENESIS OF GENIUS.— Dr. Robinovitch. 23/

age of the mother at that time. All that ia known of her is that
five years after the birth of this son she married a man "in her
own station of life." There is little to be said about tjhe gifts of
men born outside of wedlock, beyond stating that the adverse
circumstances accompanying such births and following such chil-
dren throughout life are the most powerful agents in whipping
up their potential energy to a maximum degree. Such must have
been the case with all the great men who gave laws and made
religions for the world, most of those men having been born
outside of wedlock. One might justly say that having been de-
prived of the rights and privileges of manhood they sought com-
pensation by claiming the attributes of godhood. Thus genius,
flowering on a dunghill produces flowers of exquisite hue. Two
points of interest suggest themls elves in connection with the
greatness of illegitimate children: I, — considering the fact that
adverse circumstances do develop one's energies, it is probable
that millions of children born within the bonds of wedlock would
also develop into men of note — if they had any incentive to do
so; 2, — the commercialism underlying marriages in all countries
may possibly have an influence on the birth of a considerable
number of mediocre children within the bonds of wedlock. While
this subject is of considerable interest, it is not necessary to
develop it here.

Another point of interest in the study of biographies of great
men is the profligacy of some of the parents (Beethoven's father,
Byron's father, etc.). In such cases we find that the great off-
spring came into the world while their profligate, alcoholic pro-
genitors were still young and had not yet had time to degenerate
sufficiently to permanently affect their great offspring. In many
instances of this kind the children born later died in infancy or
were degenerates. In my paper on the genesis of epilepsy I
brought to light this particular point in relation to the survival
of the first born of alcoholic progenitors. The relation of cellular
potentiality to parental age is reversed in such cases — if a large
number of children are born of such parents.

From the arguments developed here it may be stated that in
analogy to what is said of opportunity — that knocks at the door
of every man once in a lifetime, it may also be said of genius:
there is a period in the lives of parents when their cellular poten-
tiality is at its height, and the offspring conceived at such a
period, is fortunate indeed. Armed with the precious heritage of
high cellular potentiality, such an offspring sees and conquers or
conquers what he sees — not by reason of any mysterious force,
but by virtue of his capacity for work, his splendid source of

238 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

energy and ability for sustained application that his brothers and
sisters may envy but may not imitate. It is this energy that
enables the future great men to be omnivorous readers and
incessant workers even during childhood and at a tender age to
become familiar with more books and subjects than is the lot of
brothers and sisters twice their age. Life is too short for them,,
and they "can almost hear the days walk away as the heart beats
on," as a gifted and successful young man said to me. "Yesterday
is not today, and there are only a given number of days in which
one may live and work," the same worker added.

Similar reasoning expressive of pulsating energy is character-
istic of all great workers. Michael Angelo, Titian, Raphael,
Leonardo DaVinci, Shakespeare, Goethe, Beethoven, Voltaire,
Dickens, Dumas and many other men of their stamp lived and
worked three, four, five and even ten times their lives. According
to Marro, Leibnitz often spent three consecutive days and nights
in his arm chair — at work while trying to solve some problem.
Ticho Brahe made himself a prisoner for almost 21 years, working
incessantly in his observatory until his system became under-
mined. The famous astronomer, the abbot De la Caille, con-
structed for himself a headrest that enabled him to sit up nights
and cheat himself out of sleep that he considered his worst enemy.
The excessive and sustained work of Goethe cost him a "break
down" after the conclusion of each of his works. The strenuous
lives of our contemporaries are within the reach of our own
observation, and Thomas Edison speaks for more workers than
himself when he says that sleep is our worst enemy. His exu-
berant energy, disregard of sleep and contempt for overfeeding
are well known to the world.

Such is genius : the result of exuberant spirit feeding on exces-
sive work and sustained thought.

What a contrast this condition of potentiality is to that found
in mediocre persons. Those who have to handle crowds at large
are familiar with the dread of work, thought, initiative and ex-
penditure of brain force that characterizes mediocrity. How
often does not mediocrity exasperate by its shirking, shrinking
and wriggling — while trying to cheat itself out of its own time —
its lifetime? At first sight one is apt to misjudge such an attitude,
branding the subject as a lazy or unwilling individual. But the
fact should be recognized that the majority of such people, who
constitute mediocrity, are simply incapable of sustained attention
and work — such as characterizes great men. While the latter are
developing, and learning, and analyzing, and synthetizing, and
creating, — mediocrity remains largely with infantile, undeveloped

THE GENESIS OF GENIUS.— Dr. Robinovitch. 239

mentally. Dr. Lefevre justly crystallizes his conception of the
sum total of human mentality when he says that mentality is a
function and cannot be inherited.

From the facts adduced here it is difficult to conceive of the
possibility of the birth of gifted offspring from parents who are
not in harmony with themselves; the physiology and psychology
of our systems: depend so much on the state of our minds. Pro-
fessor Mosso's experiments on the variation of vascular tonus
and blood pressure according to one's psychic status are concrete
enough, showing that a person's nutrition (circulation of the
blood) is not the same when he is depressed as when he is in a
happy mood. One may hardly, therefore, accept the opinion
recently uttered by a famous lecturer and teacher in New-York,
to the effect that "happiness is not essential to make marriage a
success," and that the main object of matrimony should be pro-
creation in order to "keep the flame of human life burning" (8).
From the standpoint of the scientific principle underlying the
genesis of genius and great men, the notion of keeping the flame
of life burning by procreation is absolutely valueless. If the
"flame of life" is meant as an equivalent of numbers of human
beings, such an opinion may be valid. But if it is meant to pro-
duce men of worth — that opinion loses all value in the light of
the arguments adduced here. The conception of great men within
wedlock based on hatred is inconceivable — as has been indirectly
brought out in this paper. Besides, marriages in imiperial and
royal families — intended pre-eminently for procreation — at all
cost, have amply demonstrated the fallacy of force and calcula-
tion *when applied to human procreation.

An exposition of a few biographies appended here and taken
at random for the purpose of this study fully support the facts
presented regarding the genesis of genius.

It may be well to remark that if any inaccuracy occurs below
as regards the primogeniture either of the great men or of their
brothers or sisters, it is simply because it is difficult, and in some
cases impossible, to ascertain the exact facts in biographies. A
thorough search in biographies written by different authors often
completes the data given in one biography as regards the primo-
geniture. Unfortunately, circumstances beyond my control make
it difficult for me to undertake so extensive a work, and I must
content myself with the study of a limited number of biographies
of every man mentioned. Great men, whose biographies con-
sulted by me do not contain the desired item, are not considered
in this paper.

I wish to add also that possibly even the works quoted here

240 JOURNAL OF MENTAL PATHOLOGY. Vol. VIL, No. 5.

contain more information than I cite. The reason for such incom-
pleteness is also lack of time, preventing my thoroughly analyzing
the sources consulted. It should be borne in mind, however, that
while this study of the biographies is incomplete, it under-rates,
rather than over-rates the facts relating to genealogy in families
of great men. Thus, for instance, according to some biographies,
George Washington was the first born, but a further study shows
that he was the first born of his mother, who was a widow when
she married Washington's father, the latter having had four chil-
dren with his first wife. Under such conditions the claim made
here in regard to mature age of progenitors at the time of birth
of their distinguished offspring is correct, and the fact would not
appear if only one biography had been consulted. In the case of
Washington Irving a similar mistake is possible-— if one were to
be guided by the author's sketch, according to which it may only
be inferred that he had an elder sister, but according to Charles
Dudley Warner's biography of Irving, the latter was the eleventh
child, consequently born when his parents were quite mature.

From these and similar facts it is evident that this study loses
rather than gains by the superficial examination of biographies
used here as documentary evidence.

Reluctantly I gave up the study of biographies of the majority
of French and German men of note, as the information sought
was conspicuous by its absence in those works which I examined.

Biographic Data Chosen at Random, Showing that the
Majority of Great Men Were Born When Their Parents
Were of Mature Age. That the Majority of Great Men
Are the Youngest Born or Younger Children, While They
Are Only Occasionally First Born.

1. Vambery, Armenius. — Had an elder sister. Mother was
18 years old when she married his father. She had a strong
character and worshipped her husband for his scholarly accom-
plishments. She was widowed when 22 years of age. Had five
children by a second marriage, none of whom achieved distinction.
Her second husband was a worthless man (The Story of My
Struggles, The Memoirs of Armenius Vambery).

2. Gibbon.— Eldest of seven children; his five brothers and
only sister died in early infancy (James C. Morison).

3. Pope, Alexander. — He was not an only child, for he had
a half-sister, by his father's side, who must have been consider-
ably older than himself, as her mother died nine years before
the poet's birth. He was the only child of his mother (Leslie
Stephen).

THE GENESIS OF GENIUS.— Dr. Robinovitch. 241

4. Milton. — First born (Mark Pattison).

5. Coleridge. — Youngest child of a large family. By his first
wife his father had three children. By his second wife — ten
children: of these latter one son died in infancy, four others,
together with the only daughter of the family, passed away
before Coleridge attained his majority (H. D. Trail).

6. Gray, Thomas. — The English poet, was the only surviving
child of twelve children. The rest died in infancy from "suffo-
cation produced by a fullness of blood." In order of birth Gray
was the fifth child (The Poetical Works. Edited by Rev. John
Milford). Gray's father was thirty years old when he married
Gray's mother, who was twenty years old (Edmund W. Goose).

7. Sterne, Lawrence. — Was of the first two children ; a large
number of children born afterward, all dying in infancy. Sterne's
father was the seventh and youngest born. Mother was a widow
when she married Sterne's father. A family "continually increas-
ing by birth, only to be again reduced by death." Sterne said :
"My father's children were not made to last long" (H. D. Trail).

8. Cooper, James Fenimore. — Eleventh of twelve children
(Thomas Lounsbury).

9. Taylor, Bayard. — Fourth child; the other three died in
infancy; he was first to outlive infancy (Albert H. Smyth).

10. Poe, Edgar Allan. — Second of three children. The other
two were girls (G. E. Woodberry).

11. Emerson, Ralph Waldo. — Second of five children (Oli-
ver Wendel Holmes).

12. Irving, Washington. — Youngest of eleven children, three
of whom died in infancy. He was the eighth son (Charles Dudley
Warner).

13. Arago, Francois. — Oldest of a large number of children
(Les Contemporains. Eugene de Mirecourt).

14. Balzac. — Youngest of three children. Two elder sisters
(Ibid.).

15. Heine. — First child of four. A sister, Charlotte, and two
brothers, Gustav and Maximillian. Mother a superior woman
and highly educated ; she spoke Hebrew, French, English and
German with equal fluency. She was poetically inclined and a
thinker, as may be judged from her letters written when she was
twenty-four years of age — at the time she became engaged to
be married to Heine's father. Heine's father was of striking
physical beauty. The mother had a powerful influence on the
education of her children (Heine's Werke).

16. Eliot, George. — Youngest. Her father's fifth and her

242 JOURNAL OF MENTAL PATHOLOGY. Vol. VIL, No. 5.

mother's third and youngest child. Her mother was a superior
woman (Leslie Stephen).

17. Whittier. John Greenleaf. — If the order in which the
names of the four children are given is correct, he was the second
of the four (Mary, John Greenleaf Whittier, Matthew Franklin
and Elizabeth). His father was the youngest son of eleven chil-
dren. He married when forty-four years of age. Mother was
twenty -three years old at the time of her marriage (Carpenter).

18. Bryant,, William Cullen. — Second of seven children
(Bigelow).

19. Hawthorn, Nathaniel. — Second child; only son; two
sisters. Elizabeth was 4 years older and Louise 2 years younger
(Woodberry).

20. Dickens. — Second; eldest son of eight children (A. W.
Ward).

21. Addison, Joseph. — Eldest son of six children. Father
was a literary man (W. J. Courthope).

22. Southey. — Second child. Mother was a youngest child
(Ed. Dowden).

23. Byron. — Youngest child of three. His father had two
children with a first wife. Only son by the second marriage.
Father was a profligate (John Nichol).

24. Swift. — Younger (posthumous) child of two. Elder a
girl (Leslie Stephen).

25. Tolstoi. — Youngest of four boys ; there was a youngest
sister. "We were five children, Nicholas, Sergius, Dmitri, myself
— the youngest boy, and our youngest sister, Mashenka, whose
birth cost my mother her life." His mother was "no longer quite
young" when she married his father. His mother was "very well
educated : besides the Russian language, which she, contrary to
the majority of her equals, wrote fluently, she could speak four
foreign languages : French, German, English and Italian, and she
was very fond of art. She played the piano, and her friends have
told me that she was a mistress in telling stories" (Extracts from
"heaves from My Autobiography" ) .

26. Alfieri. — Fifth child of his mother. She had 3 children
when she married the poet's father, and he was fifty-five years
old at that time. Two children were born of this second union — a
daughter, and two years later — a son, the poet. Alfieri's sister
became a nun. The mother married a third time (Frank Hor-
ridge).

27. Galileo. — No definite information, except that there were
sisters and a younger brother, who was a "good-for-nothing."
The father was a man of erudition, a musician of merit, taught

THE GENESIS OF GENIUS.— Dr. Robinovitch. 243

his son the organ, the lute and other instruments and the theory
of music. He was clever as a writer, possessed much inde-
pendence of opinion and had a healthy distrust of dogmatic au-
thority (Frank Horridge).

28. Machiavelli. — An elder brother, Titto; sisters : Primerana
and Genevra. Father studious man. Mother com/posed verses
and hymns to the Virgin (Frank Horridge).

29. Cavour. — Younger of two sons (Frank Horridge).

30. Washington. — Fifth child of his father and first of his
mother (Washington Irving).

31. Jefferson, Thomas. — Third child of ten. It is not gen-
erally known that he was an excellent violinist (E. S. Ellis).

32. Henry, Patrick. — Second son and one of nine children.
This account does not give any information as to whether he was
the last born or not. His mother was a widow when she married
his father. Patrick Henry was born of this union. His mother
possessed undeviating probity, correct understanding and easy
elocution (William Wirts. Mrs. Syme).

33. Lincoln. — Second son. No mention is made of any more
children (R. D. Sheppard).

34. Clay, Henry. — Seventh and youngest living child of a
family of eight (Howard W. Caldwell).

35. Webster, Daniel. — Seventh and youngest child. There
were five children by a first wife and four by a second. "It is
thought that he inherited his gifts from his grandmother, who
had a striking figure, powerful mentality and commanded the
admiration of her friends (Elizabeth A. Reid).

36. Otis, James. — He had an oldest sister, but he was an eldest
son. There were thirteen children in the family (John C. Rid-
path).

37. Adams, John. — Eldest child (Samuel Willard).

38. Randolph, John. — Third son. His father was a fourth
son (R. H. Dabney).

39. Franklin, Benjamin. — The youngest of seventeen chil-
dren, by two wives. He was the youngest son of the youngest
son for many generations (Frank Strong).

40. Dewey, George. — The third son in succession. The eldest
son, Charles, was the senior of George by eleven years. The
fourth child was a daughter, Mary P. A distinguished family for
many generations back (The Life and Achievements of Admiral
Dewey. Murat Halstead).

41. Cato the Younger. — He had a half-sister, Servilia, by
the mother's side, a brother,. Caepio, and a sister, Porcia (Plu-
tarch's Lives of Illustrious Men, by John Dryden and others).

244 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

42. Napoleon.— Eighth and youngest (?) child of his mother
(Histoire de Napoleon, Elias Regnault, t. L, pp. 2-3).

Artists.

43. Michael Angelo. — Second son. First born was Leonardo.
His father was thirty-one and his mother nineteen years old when
Michael Angelo was born. He seems to have had several brothers
(Sarah Bolton).

44. Titian. — Youngest of four children: Caterina, Francesco,
Orsa and Titian. Little is known about the mother. The father
was a brave soldier and later an inspector of mines, esteemed
for his wisdom and uprightness (Sarah Bolton).

45. Raphael. — The only surviving child of four. The other
three children died in infancy. His mother was a woman of un-
usual sweetness of disposition and beauty of character. Raphael
was eight years old when she died. His father was a painter of
considerable merit and had poetic ability ; he wrote an epic of 224
pages in honor of the duke of Urbino. Raphael was eleven years
•old when his father died (Sarah Bolton).

1 46. Da Vinci, Leonardo. — Illegitimate son of his father, who
was twenty-five years old when Da Vinci was born. His father
must have been a man of considerable character, as he brought
the illegitimate child to his bride, whom he married a few months
after the birth of this son. The young wife is said to have ten-
derly cared for the adopted child. According to Sarah Bolton,
twelve other children were born to Da Vinci's father by four
wives in succession ; according to R. M. James, only eleven more
children were so born.

47. Rembrandt. — Youngest of six children: Adrian who
became a miller, Gerrit, Machteld, Cornelius, Willem, who be-
came a baker. His father was forty, and his mother thirty-five
years old when Rembrandt was born. His mother had a strong
character (Sarah Bolton).

48. Rubens. — Youngest surviving son of seven children. His
father was a learned Doctor of Laws, having taken his degree
in Rome when he was thirty-one years old. At that age he mar-
ried Rubens' mother, who was a woman of unusual force of
character (Sarah Bolton).

49. Murillo. — An only son. There was a little sister, but it
is not stated whether she was or was not younger. His father
was a mechanic (Sarah Bolton).

50. Wouwerman, Philips. — First son, but it is not stated
whether he was a first child. His father was a painter of note
(Ralph N. James).

THE GENESIS OF GENIUS.— Dr. Robinovitch. 245

51. Van De Velde, Adrian. — Youngest of the "Elder Willem"
(Ibid.).

52. Van De Velde (De Younge). — Had an elder brother
(see 51), whose youngest son was also a celebrated painter.

53. Wilkie, Sir David. — Third son of his father's third wife
(Ibid.).

54. Prud'hon or Prud'home (Pierre). — Thirteenth child of
a mason (Ibid.). *

55. Reynolds, Joshua. — Seventh child (Ibid.).

56. Gainsborough, Thomas. — Youngest son of a clothier.
Mother was an accomplished flower painter and encouraged her
son in drawing (Ibid.)

57. Holbein (The Younger). — The younger son of his father
(Ibid.).

58. — Van Dyck, Antoine. — Born by a second marriage of one
of his parents. His mother taught him to draw and his father was
quite an artist, although he became a merchant (Ibid.)

59. Landseer, Sir Edwin. — Fifth child in a family of seven.
His father was a skilful engraver and an author of some books
on the art of engraving. His mother was a gifted woman (Sarah
Bolton).

Musicians.

60. Weber, Carl Maria. — Ninth child of his father and first
of his mother. His father was fifty and his mother sixteen when
the composer was born. Father was a traveling musician and
his mother had a fine singing voice (Th. Thomas and Karl
Klauser. Also Sarah Bolton).

61. Meyerbeer.— Youngest of three brothers. One brother
was a poet, but died too young to give the world anything. An-
other brother was a celebrated astronomer. A gifted family, culti-
vated parents (Chapin).

62. Mendelssohn. — Second of four children: Fanny, Felix,
Rebecca and Paul. A distinguished family. His grandfather is
called the modern Plato (Ibid.).

63. Wagner. — The younger among seven children, but exact
order of birth is not given. There was an elder brother Albert,
and a sister Rosalie (Ibid.).

64. Bach, Johann Sebastian. — He had an elder brother, Jo-
hann Jacob, who was prepared to take his father's place as organ-
ist when Bach was doubly orphaned at the age of ten (Th.
Thomas and Karl Klauser).

65. Mozart. — Youngest of seven children. His father, the
youngest of four children, was the author of "Violin School," an

246 JOURNAL OF MENTAL PATHOLOGY. Vol. VII., No. 5.

accomplished musician. Mozart's mother was young when she
married his father. Four of her seven children died in infancy
(Ibid.)

According to Elson, five of the seven children died. The com-
poser's sister, Maria, five years older than her brother, was also
an accomplished musician. Mozart had a peculiarly shaped oral
passage, much smaller than in ordinary children, and the sound
of a trumpet "would send him into spasms of terror."

66. Beethoven. — Second son. The elder brother lived only
six days, and his two younger brothers lived to exercise a marked
but not favorable influence on the composer's fortune and happi-
ness. These two brothers and three other children born after
the composer, seem to have been the degenerate product of their
alcoholic father. The composer was born in 1770. His brothers
who survived him were born in 1774 (Casper Anton) and in
1776 (Nokolaus Johann). Those born later did not survive
(August lived two years; Anna four days, and Maria Margar-
etha about a year). The father was a tenor. He was a dissi-
pated man and a profligate (Ibid, and Sarah Tyler).

A more typical illustration of the systematic working of alco-
holism it is difficult to find.

67. Schubert, Franz Peter. — Thirteenth of fourteen chil-
dren. His father played the violin. Five more children were
born by a second wife (Th. Thomas and Karl Klauser). Accord-
ing to Sarah Tyler, the composer was the second son, and his
father had eighteen sons and daughters, most of whom died in
infancy and childhood. A remarkably musical family.

68. Schumann. — Youngest of five children (Ibid.).

69. Brahms, Johannes. — Eldest of three children. Father a
remarkable musician (Ibid.).

70. Gounod. — Father was "getting on in years" when com-
poser was born. Mother was a woman of fine qualities (Ibid.).

71. Chopin. — Father was thirty-nine years old when com-
poser was born — in 1809. His father was born in 1770 and mar-
ried in 1806. Four children were born, three daughters and the
composer, but order of the births is not stated (Ibid.).

72. Rubinstein, Anton. — Eldest boy. The other children
were not gifted. The mother was a musician and taught her
first-born music (Ibid.).

73. Haendel. — Youngest child. Father, who was a physician,
was sixty-three years old when composer was born. The mother
was his father's second wife and in the prime of life when she
married the composer's father. Haendel was a glutton, a carica-
ture of his day representing him with the head of a hog, seated

THE GENESIS OF GENIUS.— Dr. Robinovitch. 247

at the organ, while the instrument is garnished with hams, sau-
sages and other coarse foods. When blindness came upon him
he bore it with exemplary fortitude, although the musical picture
which he had composed, of Samson's blindness ("Total Eclipse"),
caused him to weep (Sarah Tyler and Elson).

74. Ysaye. — An elder brother was destined by the father to
inherit the musical career of the family. A pathetic, but interest-
ing story reveals the primogeniture of the master's brother.

"A violin solo had been assigned to me, and I played it, uncon-
scious of the fact that in putting my whole soul into the instru-
ment, I was really wrecking my brother's musical career. It is
a singular story, but after the concert, my brother came to me
and said : 'I shall never play again.' My father was there, and
asked: 'What do you mean?' My brother replied: T thought,
until I heard this boy play, that I knew something of the violin,
but I know nothing. I can never play again.' From that day
he absolutely abandoned his musical career. He told me he felt
there was no use in his playing. He had had so many years at
the instrument, working night and day, while its mastery had
been reserved for me" (The New York World, Nov. 6, 1904) .

As may be seen from the details of the biographies of the 74
great men given above, 10 only are specified as first born. Taking
these biographies in separate groups as they have accidentally
been classed in this paper, we find 6 first born of the 42 distin-
guished poets, writers, historians, statesmen, scientists, etc.
(Gibbon, Milton, Arago, Heine, Addison, John Adams) ; 1 artist
(Leonardo Da Vinci) out of 17, and two musicians (Brahms and
Anton Rubinstein) out of 15.

It is difficult to trace the ages of the parents when these ten
first born came into the world. We know that Leonardo Da
Vinci's father was 25 years old when his illustrious son came into
the world, but we know nothing of the age of his mother at the
time of his birth. A thorough search into the biographies of
these first born may be fruitful in the matter of establishing the
ages of their respective parents; but the point I have tried to
emiphasize — the mature ages of parents when they give birth to
gifted offspring, is amply demonstarted by the overwhelming
majority of 64 other than first born to 10 first born men of note —
out of 74 great men chosen at random.

references.
1. Dr. Lefevre. — Les Phenomenes de la Suggestion et
d' Auto-Suggestion. Precedes d}un •Essay sur la Psychologie
Physiologique. Brussels, 1903.

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